Medicare Hospital Benefit Period

Many seniors find that Medicare hospital inpatient care benefits are hard to understand. Instead of providing benefits for the duration of a hospital stay, Medicare measures benefit periods for inpatient care.

Medicare Hospital Benefit Period: All The Answers

What is a benefit period?
For inpatient hospital care and Skilled Nursing Facility skilled care, Medicare measures the use by a benefit period. The benefit period begins when a patient first enters the hospital as an inpatient or SNF. The period ends after 60 consecutive days without inpatient care. It is possible to have more than one hospital stay in a benefit period. In a person’s lifetime, there is no limit to the number of benefit periods.

What is covered?
Depending on whether a senior has Part A, Part B or both, Medicare will cover various costs of hospital and doctor services. These services usually include general nursing care, drugs, meals, semi-private rooms and general hospital care. Under Part A, doctor services are not included. Part B does help to cover doctor services during inpatient hospital care. Part B will also cover outpatient care services such as X-rays, lab tests, emergency and observation services. it is important to note that staying overnight in a hospital does not necessarily qualify as inpatient care.

Medicare coverage does not extend to private-duty nursing, phone and television access, personal items such as toothpaste and private rooms unless they are medically necessary for inpatient care. Prescription drugs that are able to be self-administered in outpatient care are usually not covered by Part B. Medicare Part D prescription drug plans will cover certain medications.

What does it cost?
For those who have Medicare Part A, the beneficiary who goes to a hospital for inpatient care pays a one-time hospital deductible, but does not need to pay coinsurance for the first 60 days of an inpatient stay during a benefit period. During the benefit period, a patient will need to pay coinsurance for days 61 through 90. After 90 days of each benefit period, a beneficiary may pay coinsurance for up to 60 of lifetime reserve days. A patient is allowed 60 total reserve days in their lifetime. After these have been used, the beneficiary is required to cover all hospital costs.

Under Part B, Medicare will generally cover 80 percent of the cost for inpatient and outpatient hospital and doctor services. For outpatient services, there is usually a copayment that can be different than the Part A hospital deductible. Hospital outpatient copayments can sometimes be more expensive than the inpatient hospital deductible.

Pete Blasi