US · guidance
CMS Pub. 100-01, ch. 3, § 10.4
Benefit Period (Spell of Illness)
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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