If you’ve ever insured a home or vehicle, you’re probably familiar with an insurance deductible. Typically, you pay your deductible once at the beginning of your plan year. With health insurance, for example, you pay for your health care costs until you reach the deductible, and then your health insurance provider pays for any additional care you receive for the remainder of the year.
Medicare in Illinois is slightly different, and 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 Explained
The benefit period is simply the way Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your benefit 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.
The benefit period has nothing to do with the calendar year but is based on your medical care needs. It begins on the first day you are admitted into the hospital or SNF and ends 60 days after the last day you received treatment. 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 benefit period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new benefit period.
While there is no limit to the number of benefit periods you can have or how long each benefit period can last, you must pay the inpatient hospital deductible for each benefit period.
Benefit Period Determines How Much You Pay for Care
When your benefit period begins, you are responsible for paying your Part A deductible. In 2023, Medicare recipients will pay a $1,600 deductible for each benefit period. For days 1-60 in the hospital, the coinsurance for each benefit period was $0. That means for the first two months in the hospital, you are covered with no daily coinsurance due. 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 for each benefit period is $800. With a skilled nursing facility, coinsurance was $0 for the first 20 days of each benefit period and $200.00 per day for days 21-100.
To find out where you are in your IL benefit period, refer to your Medicare Summary Notice (MSN). This document details all health care services you received in the past 3 months.