HI 00401.345 Examples of Benefit Period

Example 1:

Mr. Jones was born on 8/9/09. On 7/28/74, he entered a participating hospital. After he had been in the hospital for 2 weeks, he was discharged on 8 /11/74. On his doctor's orders, Jones entered a participating SNF on 8/15 /74, and remained there until 10/27/74. He had no further inpatient stays in 1974.

Mr. Jones' benefit period began on 8/1/74, the first day of the month he attained age 65 and was entitled to hospital insurance. The benefit period ended 12/25/74, the end of the 60-day period beginning with the date of his last discharge.

Example 2:

Mr. Smith over age 65, entered a participating hospital on 7/28/74, for treatment of a heart condition. He was discharged on 8/11/74. On 8/20/ 74, he entered a nonparticipating nursing home, which provided primarily skilled nursing care and related services. Mr. Smith remained in this facility until his discharge on 10/27/74. On 12/25/74, he was again admitted to a participating hospital because of injuries suffered in an accident. He was discharged on 1/13/75, and had no further inpatient stays in 1975.

Mr. Smith's benefit period began on 7/28/74. His stay in the nursing home began less than 60 days after his hospital stay and the benefit period was continued even though the stay was not covered. The subsequent hospital stay began less than 60 days after his discharge from the nursing home and continued the benefit period, although the condition treated was unrelated to his prior stays. The benefit period ended on 3/13/75, the end of the 60-day period beginning with the day of the last discharge.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600401345
HI 00401.345 - Examples of Benefit Period - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989