A. Definition

A benefit period (spell of illness) is the time period used in the hospital insurance program in determining whether covered Part A services can be paid for by the program. The number of days that inpatient hospital and extended care services are provided a beneficiary is related to the benefit period, as is the number of home health visits prior to July 1, 1981. Although the days for which the program will make payment are limited by the benefit period, a beneficiary is not limited in the number of benefit periods the beneficiary may have. Effective July 1, 1981, the spell of illness requirements for home health services are eliminated.

An individual may be discharged from, and readmitted to, a hospital or SNF several times during a benefit period and still be in the same benefit period if 60 days have not elapsed between discharge and readmission. The stay need not be for related physicial or mental conditions.