Because it has so many "parts," Medicare is one of
our most confusing health insurance programs around. One of the
more difficult aspects of Medicare to wrap our minds around is
"benefit periods."
Part A of traditional Medicare covers hospital care, and this is
where benefit periods come into play.
What is a Medicare Benefit Period?
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Under Part A the patient must pay a deductible
for every "hospital benefit period." Unlike most health insurance,
where deductibles must be satisfied once every year, usually
between January and December, there can be several Medicare
hospital benefit periods in a calendar year.
In 2010 the Part A deductible per benefit period is $1,100.
A benefit period begins on the day a patient enters the hospital
and ends after there has not been any hospital or skilled nursing
care for 60 days. If the patient is discharged from the hospital
or a skilled nursing facility and returns to either within 60 days
of discharge, it is considered to be the same benefit period and
there is no need to pay another deductible.
However, if the patient remains out of skilled medical care
(either hospital or skilled nursing facility) for more than 60
days and then goes back to the hospital, a new benefit period
begins and another Part A deductible of $1,100 is required.
Theoretically, although it is more than highly
unlikely, a patient could experience as many as six benefit
periods in a single calendar year.
This is one of the reasons that those with traditional Medicare
will purchase a secondary, or "MediGap" policy if they can. Most
MediGap policies will cover Medicare deductibles and co-pays,
which can reduce out of pocket costs significantly for those with
unstable medical conditions.
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