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US · guidance

CMS Pub. 100-01, ch. 3, § 10.4

Benefit Period (Spell of Illness)

activein force · 2026-08-25 – presentas-observed

A benefit period is a period of time for measuring the use of hospital insurance benefits.

It is a period of consecutive days during which covered services furnished to a patient, up

to certain specified maximum amounts, may be paid for by the hospital insurance plan.

For example, a patient is eligible for 90 days of hospital care in a benefit period and 100

days of extended care services during the same benefit period. A patient may be eligible

for as many as l50 days of hospital care in a benefit period if he/she draws on his/her

lifetime reserve. As long as a person continues to be entitled to hospital insurance, there

is no limit on the number of benefit periods he/she may have. The term "benefit period"

is synonymous with spell of illness. Since the term "spell of illness" could connote a

single illness or a particular "spell" of sickness, the term benefit period is used in

communications with the public.

History

(Rev. 1, 09-11-02)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
41bdc2380a4b642bbeb2421ca622eecec776e20fcdcd62d3a3b752ab96aabf95
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