What Is the Benefit Period for Medicare?
Grasp Medicare's benefit period: the crucial framework determining your inpatient care coverage and costs.
Medicare, a federal health insurance program, provides coverage for individuals aged 65 or older and certain younger people with disabilities. Medicare Part A, known as Hospital Insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Understanding how these services are covered hinges on the “benefit period,” which dictates how Medicare measures and pays for inpatient care.
Understanding the Medicare Benefit Period
A Medicare benefit period measures an individual’s use of inpatient hospital and skilled nursing facility (SNF) services. This period begins on the day you are admitted as an inpatient to a hospital or SNF. It continues until you have been out of a hospital or SNF for a continuous 60-day period. This means the benefit period is not tied to a calendar year but rather to specific episodes of care.
Within a single benefit period, Medicare Part A covers up to 90 days in a hospital. For SNF care, Medicare covers up to 100 days, provided certain conditions are met, such as a qualifying prior hospital stay. Should a hospital stay extend beyond 90 days, beneficiaries have access to an additional 60 “lifetime reserve days.” These 60 days can be used once over a person’s lifetime and are not renewable.
Certain services, such as hospice care and home health care, operate under different coverage rules compared to inpatient hospital and SNF stays. Hospice care focuses on comfort care for terminally ill patients and does not generally adhere to the same “benefit period” structure as hospital or SNF care. Home health services also have their own criteria for coverage and are not typically measured within the standard inpatient benefit period framework.
Cost-Sharing Within a Benefit Period
Deductibles and co-insurance amounts apply within each benefit period. A new Part A deductible is required for each new benefit period. For 2025, the Medicare Part A inpatient hospital deductible is $1,676. This deductible covers the beneficiary’s share of costs for the first 60 days of Medicare-covered inpatient hospital care within that benefit period.
For days 61 through 90 of a hospital stay, beneficiaries are responsible for a daily co-insurance amount, which is $419 per day in 2025. If a hospital stay extends into the lifetime reserve days (days 91 through 150), a higher daily co-insurance of $838 applies in 2025. After 150 days in a hospital within a single benefit period, Medicare Part A pays nothing, and the beneficiary is responsible for all costs.
Skilled nursing facility (SNF) stays also have specific cost-sharing requirements. For the first 20 days of a Medicare-covered SNF stay, there is no co-insurance. From day 21 through day 100, a daily co-insurance of $209.50 applies in 2025. After day 100 in an SNF within a benefit period, Medicare pays nothing, and the individual becomes responsible for the full cost of care.
Starting New Benefit Periods
A new Medicare benefit period begins if an individual has been out of a hospital or skilled nursing facility for 60 consecutive days. This means the previous benefit period has ended, and any subsequent inpatient admission will initiate a fresh period. There is no limit to the number of benefit periods an individual can have over their lifetime.
Starting a new benefit period means a new Part A deductible must be paid. An individual could potentially pay the Part A deductible multiple times within a single calendar year if their inpatient care episodes are separated by 60 days or more. The day count for hospital and skilled nursing facility coverage also resets with each new benefit period, allowing for another 90 days of hospital coverage and 100 days of SNF coverage.
For individuals with chronic conditions or multiple hospitalizations, tracking these periods is important for financial planning. For example, if someone is discharged from a hospital, stays home for 65 days, and then requires another inpatient admission, a new benefit period will start, and a new Part A deductible will apply. This differs from many private insurance models that typically feature a single annual deductible that applies to all covered services within a calendar year.