In Medicare, the benefit period during which Part A hospital insurance benefits are available. A benefit period begins the first time an insured person enters a hospital after his hospital insurance begins. It ends after he has not been an inpatient in a hospital or skilled nursing facility for 60 days in a row. During each benefit period the insured individual is entitled to up to 90 da3’s of hospital care, 100 days in a skilled nursing facility, and 100 home health visits. An additional lifetime reserve of 60 hospital days may be drawn upon when more than 90 days of hospital care is needed in a benefit period. There is no limit to the number of benefit periods an insured person may have. The spell of illness concept means that the program may pay for more than 90 days in a hospital in a given year, because with a new spell of illness, the benefit becomes available again. Where a spell of illness continues for a long period of time, as over a several year period, the program pays less than 90 days of care per year, because it does not pay in the second or third year if there has not been a break in the spell of illness. Additionally, under Medicare, the deductible is tied to each spell of illness. Thus an individual who is hospitalized three times in a year, each in a separate spell of illness, has to pay the deductible of the cost of an inpatient hospital day three times.
A term, used in determining Medicare benefits, which is defined as a period of time starting when the patient enters the hospital and ending at the conclusion of a 60-consecutive-day period during which the patient has not been an inpatient of any hospital or skilled nursing facility (SNF). (The patient’s actual illness ordinarily would have started prior to the hospitalization, and might or might not have concluded within the 60-day period outside the hospital.)