Sixty-Five Incorporated

Unbiased Medicare Help: (262) 223-3433


Does Medicare Advantage have benefit periods?

Some Medicare Advantage plans use benefit periods for a skilled nursing facility (SNF) stay.  Each plan determines its own charges; however, they cannot charge more than Original Medicare for SNF stays. One example: $25 per day copayment for days 1-20, $145 per day for days 21-49, the plan covers up to 100 days in a benefit period.

The majority of Medicare Advantage plans do not use benefit periods for hospitalizations. Most plans charge a specified copayment for the first so many days of a hospitalization. For example, $295 a day for the first five days, $250 a day for the first six days. No matter how many hospitalizations or how many days there are between them, the beneficiary pays the copayment. Also know that there is no Medigap policy or supplement insurance available to help cover these Medicare Advantage out-of-pocket expenses. 

If repeat hospitalizations are an issue, Medicare Advantage plans do have a maximum out-of-pocket limit. After reaching the plan’s limit, the beneficiary would not have to pay any more copayments.  

Last updated: 09-04-2018