What Is a Medicare Benefit Period & How Does It Work?
Learn how Medicare Part A structures inpatient hospital and skilled nursing facility coverage through the benefit period concept.
Medicare Part A, known as Hospital Insurance, covers costs for inpatient care. This coverage extends to services received in hospitals and skilled nursing facilities. Understanding this structure helps beneficiaries manage out-of-pocket expenses. The “benefit period” is central to determining coverage and financial responsibilities. It defines the timeframe for Medicare inpatient benefits, impacting deductibles and copayments.
Understanding the Benefit Period Concept
A Medicare benefit period tracks inpatient hospital and skilled nursing facility (SNF) care. This period begins the day a beneficiary is formally admitted as an inpatient to a hospital or a skilled nursing facility. It is not tied to a calendar year but to the admission date for inpatient services. It continues as long as the beneficiary remains an inpatient or has not gone 60 consecutive days without inpatient hospital or SNF care.
The benefit period concludes only after the beneficiary has been discharged from a hospital or SNF for 60 consecutive days. This 60-day break determines when one benefit period ends and a new one may begin. For example, if an individual is discharged but readmitted within 60 days for inpatient care, they remain within the same benefit period. There is no limit to the number of benefit periods, but each new period resets covered days and requires a new deductible.
Inpatient Hospital Coverage
Within a single Medicare benefit period, coverage for inpatient hospital stays provides a defined number of covered days. For the first 60 days of an inpatient hospital stay, Medicare Part A covers the full cost of approved services after the beneficiary pays a per-benefit period deductible. This deductible amount for 2025 is $1,676 per benefit period. The deductible is applied once per benefit period, regardless of the number of hospitalizations within that period, as long as the 60-day break rule is not met.
Following the initial 60 days, a daily copayment applies for days 61 through 90 of an inpatient hospital stay within the same benefit period. This daily copayment for 2025 is $419 per day. Once a beneficiary reaches day 91 within a benefit period, they must begin using their lifetime reserve days, or they will be responsible for all costs.
Skilled Nursing Facility Coverage
Medicare Part A also provides coverage for skilled nursing facility (SNF) care within a benefit period, with specific conditions and day limits. To qualify for SNF coverage, a beneficiary must first have a “qualifying hospital stay,” requiring at least three consecutive inpatient hospital days before SNF transfer. The SNF care must relate to the condition treated during the qualifying hospital stay, or a condition that developed while receiving SNF care for that condition.
For the first 20 days of a Medicare-approved SNF stay within a benefit period, Medicare Part A covers the full cost of services if the qualifying hospital stay requirement is met. For days 21 through 100 of the SNF stay within the same benefit period, a daily copayment applies. This daily copayment for 2025 is $209.50 per day. After day 100 in a skilled nursing facility within a benefit period, Medicare Part A no longer covers SNF services, and the beneficiary becomes responsible for all costs.
Sequential Benefit Periods and Lifetime Reserve Days
A new benefit period begins when a beneficiary is admitted to a hospital after being out of a hospital or skilled nursing facility for at least 60 consecutive days. This means a new Part A deductible applies before Medicare inpatient coverage resumes. Each new benefit period operates independently, providing a fresh set of covered days and associated cost-sharing responsibilities. This structure allows for continued coverage across different episodes of care throughout an individual’s life.
Medicare Part A includes 60 “lifetime reserve days” in addition to the standard 90 days of inpatient hospital coverage per benefit period. These days can be used only once in a lifetime for inpatient hospital stays extending beyond the 90 days covered within a single benefit period. Once a lifetime reserve day is used, it cannot be renewed or regained. A daily copayment applies to lifetime reserve days, which for 2025 is $838 per day. These days extend coverage for prolonged hospitalizations, but their one-time nature requires careful consideration.