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Medicare Benefit Period

Medicare in Illinois is slightly different, plan deductibles are charged not at the beginning of the plan year, but at the beginning of each benefit period. Understanding your benefit period and when it is can help you estimate your costs in the event you need care.

Benefit Period

The benefit period is simply the way Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your period begins the day you’re admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care. This has nothing to do with the calendar year but is based on your medical needs. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days have expired, you will still be in the same period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new period. While there is no limit to the number you can have or how long each can last, you must pay the inpatient hospital deductible for each.

Cost

When your benefit period begins, you are responsible for paying your Part A deductible. ($1,600 for 2023). For days 1-60 in the hospital, the coinsurance for each will be $0. For the first two months in the hospital, you are covered with no daily coinsurance. For days 61-90 of a hospital stay, coinsurance is $400 per day. For days 91 and beyond, coinsurance for each “lifetime reserve day” after day 90 is $800. With a skilled nursing facility, coinsurance is $0 for the first 20 days of each and $200.00 per day for days 21-100. To find out where you are in your benefit period, refer to your Medicare Summary Notice (MSN). This document details all health care services you received in the past 3 months.

 

 

 

 

 

 

 

 

 

 

References:

https://www.medicare.gov/glossary/b.html

https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

https://www.medicare.gov/coverage/skilled-nursing-facility-care.html

https://blog.medicarerights.org/what-is-a-benefit-period/ 

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