Benefit period

What it means

Medicare does not allocate hospital and skilled nursing days annually. It allocates them per benefit period, and a benefit period is defined by the person's own admissions and discharges rather than by the date.

Up to 90 hospital days and up to 100 skilled nursing days are available in each one, and the full entitlement renews each time a new benefit period begins.

The exception is the 60 lifetime reserve days on the hospital side: once used they can never be renewed.

Why it matters

It is the reason a family told that a parent has 'used up their hundred days' may be wrong. A new benefit period restores them.

It is also the reason the answer cannot be worked out from a calendar, and has to be asked of the facility's billing office.

When you are likely to meet it

• When a rehabilitation stay is being planned and somebody asks how many days are left.
• When a parent is admitted a second time in the same year.
• When a bill starts arriving in the fourth week of a stay.

Related terms

• Critical access hospitalA small rural hospital with its own Medicare designation — and the same discharge and appeal rules as any other.
• Lifetime reserve daysSixty extra hospital days a person may draw on once in their life, and never get back.
• MedicareThe federal health insurance program for people aged sixty-five and over, and for some younger people with disabilities. It does not pay for long-term care.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Qualifying hospital stayThe three consecutive inpatient days Medicare requires before it will pay for rehabilitation in a nursing facility.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — inpatient hospital care (opens in a new tab)

Sahvelo guidance that uses this

• Rehab and skilled nursing