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learn about the Medicare Part A benefit period

What Is the Medicare Part A Benefit Period?

With health insurance, a member is required to pay for their health care costs until they reach the deductible, and then their health insurance provider covers any additional medical care they receive for the rest of the year. Medicare Part A works slightly differently from standard health insurance. With Medicare Part A, deductibles are only charged at the start of each benefit period. Here is what you need to know about the Medicare Part A benefit period.  

What Is the Medicare Part A Benefit Period?

This is simply the way Medicare Part A measures Medicare beneficiaries’ use of inpatient hospital and Skilled Nursing Facility (SNF) services. This benefit period starts the day a Medicare beneficiary is admitted as an inpatient into a hospital or skilled nursing facility and ends when they have gone 60 days consecutively with no inpatient hospital or skilled nursing care.

If you need to go back to the hospital or SNF before the expiration of the 60 days, you’ll still be using the same benefit period. But if the 60 days pass without you receiving care, your benefit period will start afresh if you return to the hospital. Keep in mind that the benefit period doesn’t have anything to do with the calendar year; the period is based on your health care needs. While there is no limit on how long each benefit period can last or the number you can receive, you are responsible for paying the Medicare Part A deductible for each benefit period.

Coverage and Cost for a Benefit Period

You’ll enter the Medicare Part A benefit period as soon as you spend at least 2 nights in a hospital. You will have to pay a deductible of $1,484 (in 2021) for each benefit period before Medicare Part A starts covering the costs. Here is the breakdown of what you will pay in 2021:

  • Day 1-60: you will pay zero coinsurance for the first 60 days (benefit period) that you are an inpatient.
  • Days 61-90: during this period, you will pay a coinsurance cost of $371/day for your care.
  • Day 91 and on: you can start using your lifetime reserve days after spending 90 days in the hospital. These are 60 additional days that you can use over your lifetime, and they can be used over multiple benefits periods. However, you will be responsible for a coinsurance cost of $742/day. And once you use up your lifetime reserve, you will be accountable for all medical costs related to inpatient hospital stays.

However, coinsurance costs work in a slightly different way when you are admitted to a Skilled Nursing Facility. Here is what you will pay in 2021

  • Days 1-20: You will pay zero coinsurance cost for your stay in an SNF for the first 20 days.
  • Days 21-100: You’ll pay a coinsurance cost of $185.50/day for your inpatient care during this period.
  • Day 101 and on: You’re responsible for the costs of all the inpatient care you receive.

If you have more questions about the Medicare Part A benefit period, please don’t hesitate to contact Cornerstone Senior Advisors.