Medicare Benefit Period: What Is It, and When Does It Matter?
Your Medicare Benefit Period begins when you enter a hospital or skilled nursing facility and ends when you've been out for 60 days.
The Medicare Benefit Period is the timeframe used to calculate your costs for hospital care. At the beginning of each Medicare Benefit Period, you'll have to pay $1,632 of your medical care yourself to meet a deductible, if you don't have other coverage.
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What is the Medicare Benefit Period?
Unlike most health insurance plans where benefits are set on a yearly basis, the Medicare Benefit Period for hospital care can be any length of time.
A new Medicare Benefit Period starts when you're admitted to the hospital or other care facility. It can last any length of time. And it ends after you've been out of the hospital or facility for more than 60 days.
Your coverage resets with each Medicare Benefit Period. This is different from most other types of health insurance where coverage resets each year.
- When a Medicare Benefit Period begins, you'll have to pay the first $1,632 of costs to meet the plan deductible .
- After you meet the deductible, you'll split medical costs with your insurance or, in some cases, you might not have any costs.
Plans that use the Medicare Benefit Period
Examples of how the Medicare Benefits Period works
The timing of your hospital and nursing care will determine your benefit periods. You could be treated for different illnesses or at different locations in the same benefits period.
- Two hospital stays in the same period: If you leave the hospital to go home, but are readmitted to the hospital in a few weeks, both stays are covered under the same Medicare Benefit Period. The reason why you're rehospitalized doesn't matter — only the timing does.
- Two hospital stays in different benefit periods: Say you have to go to the hospital in January, and you go again in October. Because the stays are more than 60 days apart, they would be in different Medicare Benefit Periods. That means you would pay a deductible each time.
- Moved to a different facility: If you leave the hospital to go to a skilled nursing facility, both stays are covered under the same benefit period as long as there aren’t more than 60 days between the two stays.
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Why does the Medicare Benefit Period matter?
The Medicare Benefits Period can have a big impact on your medical costs.
Each time you start a new Medicare Benefit Period, you'll have upfront costs to pay your deductible again. This means there could be times where you might have to pay a deductible multiple times per year.
Let's say you had two hospital stays that were each a week long.
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If the hospital stays are within 60 days of each other, they'd be in the same period. That means your total medical bill would be $1,632 to pay for one deductible. The rest of your hospital care would be free because you'd have $0 daily copay.
- But if your hospital stays were several months apart, you would start a new Medicare Benefit Period for your second visit. This means you'd have to pay the $1,632 deductible at the start of your second stay, making your total medical bill $3,264. You'd still have the $0 daily copays after having the upfront cost to pay the deductible.
Medical costs in each Medicare Benefits Period
- What you pay first: Deductible of $1,632
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What you pay next: Copayment rates based on how long you need care
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Hospital stay:
- Up to day 60: No costs after you pay the deductible
- Days 61 to 90: $408 per day
- Days 91 to 150: $816 per day using lifetime reserve days
- After day 150: You pay everything
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Skilled nursing facility stay:
- Up to day 20: No costs after you pay the deductible
- Days 21 to 100: $204 per day
- After day 150: You pay everything
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Hospital stay:
Part A also helps pay for hospice and home health care.
When doesn't the Medicare Benefits Period matter?
The Medicare Benefits Period may not apply if you have Medicare Advantage, Medigap, or if you're not admitted to the hospital.
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If you're at the hospital but aren't admitted, the Medicare Benefits Period doesn't matter because treatment will fall under Part B's outpatient care, not Medicare Part A.
For example, you won't have Part A's Medicare Benefits Period if you go to the ER but aren't admitted, are under observation at the hospital, or get outpatient surgery.
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If you have Medicare Advantage (also called Medicare Part C), your coverage follows the plan you chose during enrollment. The Medicare Benefits Period won't apply to you.
A Medicare Advantage plan will typically have an annual benefit period with one deductible for all types of health care including hospital stays and doctor visits. This is a simpler system, but some plans can have a high deductible of several thousand dollars. That means you could have large medical bills before the plan's full benefits kick in.
- If you have a Medicare Supplement plan (also called Medigap), the Medicare Benefits Period usually won't matter because the most popular plans will pay for all of your costs for hospital or nursing care. However, Medigap coverage changes based on the plan you choose. So you could still have a deductible if you have one of the Medigap plans with fewer benefits.
Medigap Plan | Your costs for the Medicare Part A deductible |
|---|---|
| Plan F | $0 |
| Plan G | $0 |
| Plan N | $0 |
Can you use the Medicare Benefit Period to get more coverage?
If you have a chronic health condition, the Medicare Benefit Period may help you avoid high medical costs if you plan out the hospital stays you need.
Although you'll pay a $1,632 deductible each new Medicare Benefit Period, it can sometimes be worth it to avoid paying $408 per day after you've been in the hospital for 60 days.
Each time you start a new benefit period, your benefits will reset. That means you'll get another 60 days of free hospital care and 20 days of free skilled nursing care after paying the deductible.
So if you are able to plan some of your medical care, it can sometimes be cheaper to schedule your hospital care to be in different benefit periods, rather than paying high daily rates.
Frequently asked questions
How long is a Medicare Benefit Period?
The Medicare Benefit Period lasts until you've been out of a hospital or skilled nursing facility for at least 60 days. It can be any length of time.
Does Medicare cover rehab after a hospital stay?
Yes, Medicare covers a stay at a rehab facility if your doctor says it's necessary. If you have Original Medicare, rehab will cost the same as the cost for hospital care, and you won't need to pay another deductible if you're in the same Medicare Benefit Period. If you have Medicare Advantage, the plan you choose will determine how much you pay to stay at a rehab facility.
What happens when you run out of Medicare days?
Medicare stops paying for hospital care or skilled nursing when you run out of your 60 lifetime reserve days. This means you would have to pay the full cost of medical care yourself until you're out of the hospital or care facility for at least 60 days. Then a new Medicare Benefit Period begins and your coverage will rest.
Sources
Costs and calculations are based on the 2024 rates on Medicare.gov. Additional coverage information is from Centers for Medicare & Medicaid Services (CMS).
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