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What Is The Medicare Part A Benefit Period?

SB Solultions - Medicare Period

The Medicare Part A benefit period is the time between being admitted as an inpatient and when you have not received inpatient care for 60 days. This benefit period impacts your deductible and coinsurance, which can add up under Original Medicare. To save on your Part A out-of-pocket costs, go with a Medicare Advantage or Medicare Supplement plan.

Medicare Part A Benefit Period

When you are admitted as an inpatient in a hospital or skilled nursing facility, your Medicare Part A benefit period begins. This period ends when 60 days have gone by without you having received inpatient care.

The benefit period is used to determine all of your costs under Part A. You are charged the Part A deductible for each benefit period. Your Part A daily coinsurance for hospital, mental health facility, and skilled nursing facility care is calculated based on the number of days that have passed within the benefit period.

Impact of the Part A Benefit Period

Because there are 365 days in a year and benefit periods last just more than 60 days, it is entirely possible to have multiple benefit periods within the year. That means paying twice the deductibles and that much more coinsurance.

How to Control Part A Spending

One of the ways you can limit your spending on Medicare Part A care is by choosing a Medicare Advantage plan. These plans have an out-of-pocket maximum limit, unlike Original Medicare, so you don’t have to worry about spending more than, say, $5,000 in out-of-pocket for the year, regardless of how high your hospital expenses get.

Medicare Advantage plans have the same Medicare Part A and Part B coverage as Original Medicare, except your plan pays for the care instead of Medicare directly. You show your plan card to your provider, not your Medicare card. Remember, though, that you still have to pay your Medicare premiums on top of your plan premiums.

Another way to save money on your Part A expenses is to purchase a Medicare Supplement plan. These plans, also known as Medigap, help to pay for the out-of-pocket expenses leftover from Medicare Part A and Part B. They can cover your Part A coinsurance and hospital costs as well as the Part A deductible. Medicare Supplements only cover your costs, not your health care. They have the advantage of saving you money without limiting your coverage area.

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions are made by Medicare about whether something is covered.
  3. Local coverage decisions are made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

 

If you need more information feel free to reach out via phone: (912) 687-3094

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