What Is a Benefit Period for Medicare?

Medicare Part A provides coverage for inpatient hospital stays and skilled nursing facility (SNF) care. Understanding the concept of a “benefit period” is fundamental for beneficiaries to navigate their coverage and financial responsibilities for these services. This framework determines how Medicare calculates its payments and what portion of the costs a beneficiary is expected to cover. The benefit period is a specific unit of time that impacts deductibles and coinsurance amounts for covered services.

Understanding the Benefit Period Framework

A Medicare benefit period is not tied to a calendar year but instead relates to a spell of illness, providing a continuous measure of care. This framework primarily applies to Medicare Part A, which covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services. A new benefit period begins when a Medicare beneficiary is formally admitted as an inpatient to a hospital or a skilled nursing facility. It encompasses the services received during that period of care.

The duration of a benefit period continues until the beneficiary has been out of a hospital or skilled nursing facility, or has not received skilled care in either, for 60 consecutive days. This means that a single benefit period can cover multiple admissions if there isn’t a 60-day break in care between them. For instance, if a person is discharged from a hospital and then readmitted within 60 days for a related or unrelated condition, it falls under the same benefit period. This structure ensures that continuous care is grouped together for billing and coverage purposes.

Covered Days and Financial Responsibilities

Within each benefit period, Medicare Part A outlines specific coverage days and financial responsibilities for inpatient hospital and skilled nursing facility care. For inpatient hospital stays, Medicare Part A covers up to 90 days. In 2025, beneficiaries are responsible for an inpatient hospital deductible of $1,676 for each benefit period, which covers the first 60 days. For days 61 through 90, a daily coinsurance of $419 applies.

Beyond the initial 90 days, Medicare provides an additional 60 “Lifetime Reserve Days.” These can be used once a beneficiary has exhausted their standard 90 days of hospital coverage within a benefit period. These 60 days are non-renewable and are drawn from a beneficiary’s lifetime allotment. For each Lifetime Reserve Day used, a daily coinsurance of $838 is charged in 2025. Once these lifetime reserve days are depleted, the beneficiary becomes responsible for all hospital costs if the stay continues.

For skilled nursing facility (SNF) stays, Medicare Part A covers up to 100 days per benefit period, provided the stay follows a qualifying inpatient hospital stay of at least three consecutive days. The first 20 days of a Medicare-covered SNF stay have no coinsurance. From day 21 through day 100, a daily coinsurance of $209.50 applies in 2025. After day 100, the beneficiary is responsible for all costs of the SNF stay.

Initiating a New Benefit Period

A new Medicare benefit period begins when a beneficiary has been out of a hospital or skilled nursing facility for at least 60 consecutive days. This 60-day break in care effectively resets the clock for Medicare Part A coverage. For example, if a beneficiary is discharged from a hospital and remains out of inpatient care for 60 days, any subsequent inpatient admission will initiate a brand-new benefit period. There is no limit to the number of benefit periods a beneficiary can have.

When a new benefit period begins, the inpatient hospital deductible resets, meaning the beneficiary will again be responsible for this amount for the first 60 days of a new hospital stay. Similarly, the full complement of covered days for both hospital and skilled nursing facility care becomes available again, along with their respective coinsurance structures. This mechanism allows Medicare to provide coverage for multiple distinct episodes of inpatient care over time, rather than a single annual allowance.