A benefit period under Medicare is also referred to as a “spell of illness”. It defines a period of time over which Medicare benefits pay and certain co-pays apply.
A spell of illness begins on the day a Medicare patient is admitted to a hospital or skilled nursing facility and continues until 60 consecutive days after which the patient has received no skilled care. For example, if a Medicare patient is admitted to the hospital for a week then to a rehabilitation center for two months and then goes home. If the patient returns to the hospital after only 10 days at home, the return to the hospital is still part of the original benefit period. However, if the patient goes to the hospital 90 days after returning home, the return to the hospital marks the beginning of a new spell of illness.
There is no limit to the number of benefit periods in a Medicare recipient’s life time. Each spell of illness is subject to a deductible and co-payments. There is a deductible associated with hospitalization. There are also co-payments due for skill nursing care in a rehabilitation center. Individuals with a Medicare Advantage Plan should check with their plan to determine the applicable costs associated with a spell of illness.
Medicare patients or their caregivers must understand the beginning and end of a spell of illness to calculate the health care costs not covered by Medicare.
