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What Is Medicare Benefit Period

If I Retire At Age 62 Will I Be Eligible For Medicare At That Time

Understanding the New Medicare Benefits Ahead of the Annual Enrollment Period

Medicare is federal health insurance for people 65 or older, some younger people with disabilities, and people with end-stage kidney disease. Most commonly, you are eligible for Medicare when you turn 65, but there are other health insurance options if you are younger and do not have coverage through you or your spouses employer.

What you should know
1. The typical age requirement for Medicare is 65, unless you qualify because you have a disability. 2. If you retire before 65, you may be eligible for Social Security benefits starting at age 62, but you are not eligible for Medicare.
3. You have options for health insurance if you are too young for Medicare. You may obtain it through your employer, or you can purchase from private-sector insurance companies through the health insurance exchange. You may be eligible for Medicaid, which is based on income. 4. If you retire before you are 65, you may be eligible for employer-provided group health insurance under the Consolidated Omnibus Budget Reconciliation Act .

Medicare was established in 1965 in order to provide health coverage for seniors who would otherwise not be covered by employer-sponsored health insurance plans. If you retire at the age of 62, you may be eligible for retirement benefits through social security, but early retirement will not make you eligible for Medicare.

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A Benefit Periods: Multiples

If youve had private health insurance in the past, youre probably accustomed to annual benefit periods. You may have a deductible to meet before coinsurance or copayments kick in.

There may be an out-of-pocket maximum on what you spend over the course of the year. When your plan year ends, everything resets and a new benefit period begins.

Medicare Part A is different. Its benefit periods arent annual theyre based on how long youve been discharged from the hospital. You can actually encounter multiple Part A benefit periods in the same calendar year if youre hospitalized more than once.

A benefit period under Part A begins the day youre admitted to the hospital and ends when youve been discharged for at least 60 days. If youve been out of the hospital for more than 60 days and are admitted again, a new benefit period begins.

Each benefit period requires that you meet a deductible. Its $1,600 in 2023, but can change each year. Because hospital care is generally pretty expensive, you should brace yourself to pay that full amount each time youre in the hospital.

After meeting your deductible, you pay nothing out of pocket for hospital costs for your first 60 days you are admitted. For stays beyond that, you can expect to pay coinsurance.

It should be unlikely that youd encounter a lengthy stay that would require coinsurance payments, barring a serious medical episode.

How Much Does Medicare Part A Cost

Even though Medicare Part A covers many of your expenses if youre hospitalized or qualify for skilled nursing coverage, you may still have some out-of-pocket costs.

Premiums. Most people dont pay premiums for Medicare Part A because they or their spouse had Medicare taxes deducted from their paychecks for at least 40 quarters of work, the equivalent of 10 years. Youll pay $278 a month in 2023 if you or your spouse paid Medicare taxes for 30 to 39 quarters, or $506 a month if you paid Medicare taxes for fewer than 30 quarters.

Deductible. You must pay a deductible before Part A coverage begins. In 2023, the Part A deductible is $1,600 per benefit period.

Copayments or coinsurance. This is the portion of the cost that you pay after youve met your deductible. Part A has no copay for hospital stays of up to 60 days in one benefit period. In 2023, copays for a longer stay may include:

  • $400 a day for days 61 to 90.
  • $800 a day after day 90 for up to 60 lifetime reserve days.
  • All costs beyond your lifetime reserve days. Each lifetime reserve day may be used only once, but you can apply the days to different benefit periods.

Copays for skilled nursing facility stays in 2023:

  • Nothing for days 1 to 20.
  • $200 a day for days 21 to 100.
  • All costs beyond day 100.

You can buy Medicare supplement insurance, known as Medigap, to cover the deductible and many of these out-of-pocket costs.

Keep in mind

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Medicare Part A Coverage And Benefits

Original Medicare is made up of two parts: Medicare Part A and Part B. Your Medicare Part A coverage provides protection for hospital inpatient care, skilled nursing facilities, hospice, and home health care.

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For most seniors receiving Medicare Part A benefits, the coverage has a $0 monthly premium. However, you must meet certain criteria. If not, you may need to pay a premium each month.

Below, we discuss everything you need to know about Medicare Part A, including eligibility, coverage, enrollment, and more.

Medicare Benefit Period Explained

Medigap Planners

The Medicare benefit period is simply the way Original Medicare measures your use of inpatient hospital and skilled nursing facility services. Your benefit period begins the day youre admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care.

The benefit period has nothing to do with the calendar year, but is based on your medical care needs. It begins on the first day you are admitted into the hospital or SNF and ends 60 days after the last day you received treatment. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days has expired, you will still be in the same benefit period. However, as soon as 60 days has passed with no care, if you return to the hospital, you will start a new benefit period.

While there is no limit to the number of benefit periods you can have or how long each benefit period can last, you must pay the inpatient hospital deductible for each benefit period.

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Do I Have Other Options

If you want extra help with your inpatient care, there are options you can look into. One is a Medigap plan that covers hospital or skilled nursing facility coinsurance. All Medigap plans will cover Part A coinsurances and hospital costs for a year after Medicare benefits end. Most plans will also cover at least a portion of skilled nursing facility care coinsurances. Only Plans A and B offer no coverage, while Plans K and L offer a percentage of coverage.

Many Medicare Advantage plans offer some form of hospital or skilled nursing facility coverage.

It may also be worth investigating a Medicare Advantage plan. Many Medicare Advantage plans offer some form of hospital or skilled nursing facility coverage. This coverage differs from plan to plan, though.

If this coverage is important to you, we recommend working with a licensed sales agent who can help you choose a plan. Whether youâre looking for a Medigap or Medicare Advantage plan, the Medicareful Plan Finder tool can help you find one.

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If you find yourself admitted to an inpatient care facility, itâs reassuring if you know your Medicare plan will cover your needs. Understanding what is covered, and when itâs covered, is critical to ensuring youâre never caught with shocking charges. This is why knowing your benefit periods is so important.

How Do Lifetime Reserve Days Work With Medicare

Part A covers inpatient hospital care, skilled long-term facility, and more, for up to 90 days. But if you ever need to extend your hospital stay, Medicare will cover 60 additional days, called lifetime reserve days.

For instance, if your hospital stay lasts over 120 days, you will have used 30 lifetime reserve days. Please note that youll pay a coinsurance for each lifetime reserve day you use. You can only use your lifetime reserve days once.

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When Does Medicare Kick In If Youre Enrolled Automatically

If you are automatically enrolled in Medicare whether due to age or disability your Medicare benefits kick in on the first day of the month you become eligible. So, if your birthday is on April 22, your Medicare benefits begin on April 1. The same is true if April marks your 25th month of collecting disability benefits.

The only exception is if your birthday is on the 1st of the month. In that case, your Medicare benefits begin the preceding month. So, if your birthday is April 1, your Medicare coverage starts on March 1.

What Are The Costs And Scope Of Coverage For A Medicare Benefit Period

Competitive benefits during the Medicare annual enrollment period with Optima Health

Lets discuss how the benefit periods in the Medicare Part A plan are structured. If you want to stay at a medical center for at least two midnights, you will begin a benefit period.

Heres what you will need to pay in 2021:

  • Initial deductible: Your deductible is equal to $1,484 during each benefit period. Medicare will begin covering costs once you pay this amount.
  • Day 1 to Day 60: During this timeframe, you will pay $0 deductibles during your first 60 days as an inpatient.
  • Days 61 to 90: During this benefit period, you will be charged a $371 daily coinsurance fee for your medical care.
  • Day 91 and beyond: After the 90-day period, you will begin to use your lifetime reserve days. You have 60 more days after day 90 that you can use for the rest of your life. They can be used in conjunction with other benefit periods. For each lifetime reserve day used, you would pay $742 in copayments. After you have used up your 60 days period, you will be liable to pay compensation associated with inpatient stays that last more than 90 days.

Post ambulatory care after clinic stay

An estimated 40% of participants with Medicare coverage require post-ambulatory care after a hospital stay, such as the SNF . When youre in a skilled nursing facility, your copayments work a little differently. The following is a breakdown of those charges in 2021:

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How To Find Medigap Plans That Cover Your Deductibles

Medicare Supplement insurance can cover the Part A deductible. This way, you dont have to worry about paying multiple Part A deductibles during the year. Medigap insurance like Plan F or Plan G can leave you with little to no out-of-pocket costs.

We have licensed insurance agents who know all about everything Medicare-related. They can impart their wisdom to you when making this valuable decision. Plus, these agents are on standby to take your call for free!

Give our agents a call to see which Medigap plan will make the most sense for you. If you just want to compare online, fill out an online rate form to see the best plans in your area.

Do The Hospital And Snf Benefit Periods Overlap

Yes and no. Weve talked about hospital and skilled nursing facility coverage as if theyre separate. But in reality, these benefits work together. Because you cant get SNF care unless youve spent three days as an inpatient at a hospital first, these benefits go hand in hand.

Lets say that during your hospital stay for pneumonia, your doctor determines that you need close observation and care as you recover from the infection. He orders treatment at a skilled nursing facility, which starts the day youre released from the hospital .

Your Part A benefit period started the day you were admitted to the hospital . Because youre already inside of a benefit period, Medicare will cover up to 100 days of SNF care while youre in this benefit period. Once you recover from the pneumonia and decide to go home, youll still be inside the same benefit period until its been 60 days since you received SNF care.

The Part A benefit runs from the day youre admitted to a hospital or skilled nursing facility and ends once youve gone 60 consecutive days without needing care from either one. During that time, you have 100 days of coverage for SNF care at your disposal. This maximum resets with each benefit period.

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Skilled Nursing Care Within 30 Days

4) You must enter a Medicare-certified skilled nursing facility within 30 days after leaving the hospital.

In order for Medicare to pay for care in a skilled nursing facility, you first have to be hospitalized as an inpatient. That inpatient stay must be at least three days long, not including the day of transfer to the nursing facility.

However, Medicare could still pay for care in a skilled nursing facility if you come from home rather than from a hospital. This is the case if you are within an active Medicare benefit period.

The trick is that you would have to require skilled nursing care daily or skilled therapy services at least five days per week and be placed in the SNF within 30 days of your hospital discharge.

Coinsurance for your stay in a skilled nursing facility is different than your inpatient hospital stay, though both are covered by Part A. The Part A deductible covers your first 20 days in an SNF. Days 21 to 100 require a coinsurance of $200 per day in 2023, and you will pay full expenses out of pocket for any subsequent days.

Medicare does not offer lifetime reserve days for SNF care, although many Medigap plans do offer partial or full payment toward your SNF coinsurance costs.

What Are The Different Parts Of Medicare

Medicare Consulting

When it comes to enrolling in Medicare benefits, seniors have many choices. It can be confusing to know the difference between Medicare Supplement Plans, Medicare Replacement Plans and Medigap Policies. These increasingly popular plans can help you cover costs that Traditional Medicare doesnt, including co-insurance, co-pays, deductibles and more. In this section we highlight each option.

Medicare Part A Helps pay for inpatient hospital care, skilled nursing facility care, home health, and hospice care.

Medicare Part B Helps pay for physician services, medical services, lab tests, medical supplies and outpatient hospital services. Most people will pay a monthly fee for coverage, as well as an annual deductible.

Together, Part A and Part B are called Traditional Medicare. You may be eligible for premium-free Medicare if you are a U.S. citizen or permanent legal resident that has paid Social Security for at least 10 years, and meet at least one of the following criteria:

  • You are age 65 or over and receiving Social Security retirement benefits
  • You are permanently disabled and received Social Security disability for 24 months
  • You have Lou Gehrigs Disease
  • You have End Stage Renal Disease

With Traditional Medicare, you do not need to get prior authorization from Medicare or your primary doctor. Enrollment in Part A and Part B is not automatic. To apply for Traditional Medicare benefits, you must contact Social Security.

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Does Medicare Start On The First Day Of Your Birth Month

Your Medicare coverage generally starts on the first day of your birthday month. If your birthday falls on the first day of the month, your Medicare coverage starts the first day of the previous month. If you qualify for Medicare because of a disability or illness, in most cases your IEP is also seven months.

A Lifetime Reserve Days

Medicare Part A covers an unlimited number of benefit periods, and it helps pay for up to 90 days of care for each one. After 90 days, its possible to tap into lifetime reserve days.

Lifetime reserve days are like a bank account of extra hospital days covered by Medicare. You have 60 extra covered days in your account that you can use over your entire life. Lifetime reserve days may be applied to more than one benefit period, but each day may be used only once.

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Skilled Nursing Facility Benefit Periods

Medicare Part A also covers skilled nursing facility care. And as with hospital admissions, SNF admissions allow for multiple benefit periods in a single year.

Costs differ for SNF care, though. In 2023, youll pay:

  • $0 copay for days 1-20
  • $200 copay per day for days 21-100
  • All SNF costs for days 101+

The benefit period for skilled nursing facility care starts on the day youre admitted and ends once youve gone 60 days in a row without getting SNF care same rules as hospital inpatient care.

Note that skilled nursing coverage doesnt have lifetime reserve days. Once you hit day 101 in each benefit period, youll have to pay for the cost of care yourself for however long you need it.

There are also some other things you should know about how coverage works for SNF care.

Medicare will only cover skilled nursing facility care if youve spent three days as an inpatient at a hospital first and you have a doctors order for the SNF care that says its necessary. There are a few other requirements, but these are the basics.

Before your benefit period can even start and before Medicare will cover your SNF care, you have to have spent three days as a hospital inpatient.

This excludes whats known as observation status. If youre at a hospital but havent been formally admitted as an inpatient, your time wont count towards the SNF minimum. Check with your doctors and the hospital to make sure of your status.

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