Medicare Part A Benefit Period: 60 Days Explained

A Medicare Part A benefit period is not a calendar year. It begins when you are admitted to a hospital as an inpatient or enter a skilled nursing facility for covered care, and it ends only after you have gone 60 days in a row without inpatient hospital care or skilled nursing facility care. If you start a new benefit period, you may owe a new Part A deductible.

This rule applies to Original Medicare, which is Medicare Part A and Part B administered by the federal program. The part that often causes confusion is that a trip home, a doctor visit, or outpatient observation care does not automatically start a new benefit period. What matters is whether you have had 60 consecutive days without the types of inpatient or skilled nursing facility care Medicare counts for this purpose.

How the 60-day Medicare Part A clock works

The 60 days are consecutive days. Medicare starts counting after your covered inpatient hospital stay or covered skilled nursing facility stay ends. You do not need to stay home for 60 days. You can see your regular doctor, receive outpatient services, or have other health care during that time.

• Day 1: You leave inpatient hospital care or covered skilled nursing facility care.
• Days 1 through 60: You have no inpatient hospital care or skilled nursing facility care that continues the benefit period.
• After 60 full days: The benefit period ends. A later qualifying inpatient stay begins a new one.

According to Medicare.gov's inpatient hospital coverage guidance, you can have more than one benefit period in a year. That is why Part A costs are not limited to one deductible per calendar year.

When you may owe another Part A deductible

You may owe another Part A deductible when a new benefit period begins. For example, if you are discharged after an inpatient hospital stay and then admitted again 30 days later, you are generally still in the same benefit period. If you are admitted again after you have had 60 consecutive days without inpatient hospital or skilled nursing facility care, the later stay generally starts a new benefit period.

The deductible is tied to the benefit period, not to the number of hospital admissions. Medicare also has separate daily cost-sharing rules for longer hospital stays and for covered skilled nursing facility care. Medicare publishes the current amounts each year in its official Medicare costs information.

If you have a Medicare Supplement Insurance policy, also called Medigap, your policy may help with some Original Medicare cost sharing. Review your plan documents for the benefits and limits that apply to you.

Skilled nursing facility care follows the same benefit period

Part A can cover limited skilled nursing facility care when Medicare's requirements are met. A skilled nursing facility is a licensed facility that provides skilled nursing or rehabilitation services, and it is different from long-term custodial care. The same 60-day break is used to determine when the benefit period ends for hospital and skilled nursing facility coverage.

Coverage for a skilled nursing facility has additional conditions, including a qualifying inpatient hospital stay and a need for daily skilled care. Read Medicare.gov's skilled nursing facility coverage details before assuming a facility stay will be covered by Part A.

Part A benefit periods do not determine every Medicare cost. Outpatient doctor services and many preventive services are usually considered under medicare part b coverage, while your employer coverage or other insurance can affect what you pay.

What Medicare Advantage members should know

Medicare Advantage plans must cover all services that Original Medicare covers, except hospice care, which Original Medicare generally covers even when you are enrolled in a Medicare Advantage plan. However, a Medicare Advantage plan can use its own network rules, prior authorization rules, and cost-sharing amounts for covered services.

If you have Medicare Advantage, check your plan's Evidence of Coverage before a hospital or skilled nursing facility stay. A guide to medicare prior authorization can help you understand why a plan may ask for approval before some services. If you also have retiree, union, or current employer coverage, see medicare and employer coverage to understand how multiple types of coverage can work together.

For related questions about benefits outside a hospital stay, you can also explore medicare coverage for mental health services and medicare and social security.