TN 1 (10-22)

HI 00401.345 Examples of Benefit Period

Example 1:

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

Jones' benefit period began on 8/1/74, the first day of the month Jones 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 the last discharge.

Example 2:

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

Smith's benefit period began on 7/28/74. Smith's stay in the nursing home began less than 60 days after the 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 discharge from the nursing home and continued the benefit period, although the condition treated was unrelated to 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.