Some Medicare deductibles are based on the calendar year, and one is based on a benefit period. Understanding the difference between a benefit period deductible and a calendar year deductible is important for you to better plan your healthcare budget.

Now that you got the basics, let’s dive deeper into the details of a calendar year vs. a benefit period.

Do Medicare Benefits Follow the Calendar Year?

Yes, Medicare benefits follow the calendar year since benefits change at the start of each new year.

Medicare deductibles and premiums reset annually on New Year’s Day. Since the coverage resets on the 1st day of the year, that’s when you can expect deductible and premium increases to go into effect.

Beneficiaries are notified of these changes in October or November, near the middle of the Annual Enrollment Period for Medicare Advantage plans.

Medicare premiums and deductibles change in cost during the new calendar year, but benefit periods are slightly different and encompassed into the calendar year.

How Does a Medicare Benefit Period Work?

The Part A Medicare benefit period begins the day of your hospital or skilled nursing facility admission and ends once you’ve been out of the hospital for 60 consecutive days.

It’s possible to have multiple benefit periods during the calendar year. Having multiple benefit periods means you pay the Part A deductible more than once.

For example, you go to the hospital in February and return home for 75 days before having to go back. Since it’s been over 60 days since you’ve been in the hospital, you’ll be in a new benefit period and must pay the Part A deductible again.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services

What Is The Difference Between a Calendar Year vs. a Benefit Period?

There can be several benefit periods in the calendar year. But there is some benefit to having a Part A benefit period.

For example, if you go into the hospital on December 29 and leave the hospital on January 2, that is only one benefit period, and you’ll only pay the deductible once despite being in two different calendar years.

What are Lifetime Reserve Days with Medicare and How Do They Work?

Lifetime reserve days cover you an additional 60 days beyond the 90 days Medicare covers you in a hospital or skilled nursing facility. So, if you’re in the hospital for 100 days, you’ll use 10 lifetime reserve days.

Lifetime reserve days are only available one time, once you’ve used them up there are no more.

How do Medicare Annual Deductibles Work?

The annual deductibles like the Part B deductible or the Part D deductible reset each calendar year. So, you pay the cost of your care first, this is you meeting the deductible.

Then, once you meet the calendar year deductible, you’re done until the next year. The Part A deductible is NOT a calendar year deductible, this is a deductible that applies per benefit period.

Do Medicare Advantage Plans have Benefit Periods?

For the most part, a Medicare Advantage plan has copayments or coinsurances for hospital or skilled nursing facility care. In the rare case that there is a benefit period on a Part C policy, it’s likely only going to apply to the skilled nursing facility.

Medicare Advantage plans do have a maximum out-of-pocket. Once you’ve spent so much money on covered expenses for the year, the plan starts picking up the rest of the covered medical bills.

What is a Calendar Year Maximum Out of Pocket?

The maximum out-of-pocket (MOOP) runs on a calendar year. During the calendar year, once you spend a certain amount on covered services, around $9,000, the insurance carrier begins to pick up the rest of your covered medical bills and you don’t pay any more out-of-pocket.

When it comes to the maximum out-of-pocket, the amount you contributed to previous years won’t be applied. Only expenses from the current calendar year, that are approved by Medicare will count towards your MOOP.

FAQs

How long is a Benefit Period?

The Medicare Part A benefit period starts when you’re admitted to the hospital or skilled nursing facility and the benefit period ends once you’ve been home for 60 consecutive days.

Then, since you’ve hit the new benefit period, if you have a medical emergency you might need to pay a larger portion of the costs yourself.

What is the longest you can stay covered by Medicare while in the hospital?

Medicare coverage is available for the first 90 days in a hospital per benefit period. You do have an extra 60 lifetime reserve days.

The most you could stay in a hospital with Medicare covering a portion of the benefits is 150 days.

What is the Medicare Benefit Period for skilled nursing?

The skilled nursing facility benefit period is the Part A benefit period and works just the same. There may be specific information needed about your condition to ensure eligibility for a skilled nursing facility.

How To Find Medigap Plans That Cover Your Deductibles

Medicare Supplement insurance can cover the Part A deductible. This way you don’t 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 you’re 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.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.