As Medicare beneficiaries consider their health-care options in 2025, they must understand the key concept of the Medicare benefit period.
This concept differs from other traditional plans that follow a yearly calendar basis. Medicare Part A bases its billing on these periods, as well as how hospital and skilled nursing facility (SNF) charges are calculated. With costs increasing in 2025, understanding how these periods work is more important than ever.
What is the Medicare Benefit Period?
A benefit period begins on the day a person is admitted to a hospital or a skilled nursing facility as an inpatient and ends when they have not received inpatient care for 60 days straight. If a person returns after 60 days, a new period begins, and they must pay the Part A deductible again.
This setup allows a person to have multiple benefit periods in a single year, each with its own cost.
Unlike other types of health insurance, the deductible for a Medicare benefit period is not based on the calendar year. You could pay more than one deductible in the same year.
2025 costs per benefit period
According to Medicare Interactive, people can expect to pay the following amounts in 2025 for each benefit period:
Inpatient Hospital Stays (Medicare Part A)
Deductible: $1,676 per benefit period
Days 160: $0 extra cost
Days 6190: $419 each day
Days 91 and more: $838 per “lifetime reserve day” (up to 60 days in a lifetime)
After lifetime reserve days: All costs are on the person
Skilled Nursing Facility (SNF) Care
Days 120: $0 extra cost
Days 21100: $209.50 each day
After day 100: All costs
These costs are reset with each new benefit period, which can be particularly burdensome for those who have multiple hospital stays in a given year.
Here is how Humana explains how benefit periods work:
Vivian was in the hospital from September 915 and paid the $1,676 deductible. She went back on November 27. Since more than 60 days had passed, a new benefit period started, and she had to pay the deductible again.
Richard went into the hospital on March 1 and left on March 10. He went back a week later for something else. Since fewer than 60 days had passed, he stayed in the same benefit period and did not owe another deductible.
Why is it really important to understand
Understanding how benefit periods work is critical for planning health-care costs. Many people believe Medicare operates like other plans, with a yearly deductible, but each benefit period may result in new costs.
To cover these costs, some people purchase Medigap (Medicare Supplement) plans, which may cover the Part A deductible and other shared expenses.
By 2025, Medicare benefit times will continue to play a significant role in how hospital bills are generated and paid. The initial Part A cost is $1,676, so people should be aware that if they visit the hospital more than once, they may have to pay this large fee multiple times per year.
It is critical to understand when these times begin again in order to avoid unexpected costs and help people plan their care effectively.
