Medicare Part A, Benefit Periods and DeductiblesPosted by Medicare Made Clear
Medicare Part A is hospital insurance. It helps pay for inpatient care and services you receive in a hospital or skilled nursing facility.
Medicare manages Part A coverage and costs based on a “benefit period.” The Part A deductible, for example, is charged for each benefit period.
Let’s explore how this all works.
What is a Benefit Period in Medicare Part A?
A benefit period is a way to measure and account for the Part A benefits you use.
A benefit period begins the day you are admitted to a hospital or skilled nursing facility. It ends when you have been out of the hospital or facility for 60 days in a row.
Part A covers an unlimited number of benefit periods. However, each benefit period includes a set number of covered inpatient days.
How Many Hospital Days Are Covered in a Benefit Period?
Medicare Part A covers up to 90 inpatient days in one benefit period. After that you may use lifetime reserve days, which are extra covered inpatient days. Each lifetime reserve day may be used only once. You have 60 reserve days that you may use over the course of your life.
How Many Hospitalizations Can a Benefit Period Include?
One benefit period may span two or more hospitalizations. For example, let’s say you’re admitted to the hospital and released after a short stay. You have a set-back a few days later and are readmitted. The benefit period that began with your first hospitalization is still in effect when you go back in.
A new benefit period begins only after you’re out of the hospital for 60 days in a row.
How Does the Medicare Part A Deductible Work?
Medicare Part A charges a deductible for each benefit period, rather than for the year.
The Part A deductible covers the first 60 inpatient days in one benefit period. Days 61 – 90 in a benefit period come with a daily copay as do any lifetime reserve days used after that.
Part A charges just one deductible per benefit period, even if the period includes multiple hospital stays.
But two hospital stays separated by 60 or more consecutive days out of the hospital count as two benefit periods. Part A would charge two deductibles, one for each period.
These examples may help you understand how this works:
- Two hospital stays, one benefit period, one deductible
- Two hospital stays, two benefit periods, two deductibles
How Many Hospital Days Will Medicare Advantage Plans Cover?
Each Medicare Advantage plan (Part C) sets its own cost-sharing terms. Plans may or may not charge deductibles for hospital stays. You can get specific plan information by calling the insurance company offering the plan or by visiting the company’s website.
Key Points to Remember
- With Original Medicare, you pay a Medicare Part A deductible for each benefit period.
- A benefit period begins when you enter the hospital and ends when you are out for 60 days in a row.
- One benefit period may include more than one hospital stay.
For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.