What should I know about benefit periods for Original Medicare?
Benefit periods are a key part of the payment structure for Original Medicare. A benefit period begins the day of admission to a hospital or skilled nursing facility (SNF). It ends when there have been no hospitalizations or SNF stays for 60 days. If there is another hospital or SNF stay in the same calendar year, a new benefit period begins. The beneficiary must pay the coinsurance, deductibles, or copayments applicable for each benefit period.
Here’s an example of how the benefit periods work.
Gregory George was hospitalized from January 7-13. He paid the Part A deductible ($1,408 for 2020). He was rehospitalized March 24-26. Because this was more than 60 days after discharge in January, he was subject to another Part A deductible for the hospital stay.
After a fall on April 28, he was readmitted for three days. Because this stay was less than 60 days from the last discharge in March, it is in the same benefit period so Gregory did not incur any further out-of-pocket charges for that stay.
Many Medigap policies cover the hospitalization deductible and coinsurance. Most plans also cover the SNF coinsurance.
Learn about Medicare Advantage and benefit periods.Last updated: 12-26-2019