SSI Blog
Medicare in Illinois is slightly different, plan deductibles are charged not at the beginning of the plan year, but at the beginning of each benefit period. Understanding your benefit period and when it is can help you estimate your costs in the event you need care.
Benefit Period
The benefit period is simply the way Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your period begins the day you’re admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care. This has nothing to do with the calendar year but is based on your medical needs. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days have expired, you will still be in the same period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new period. While there is no limit to the number you can have or how long each can last, you must pay the inpatient hospital deductible for each.
Cost
When your benefit period begins, you are responsible for paying your Part A deductible. ($1,600 for 2023). For days 1-60 in the hospital, the coinsurance for each will be $0. For the first two months in the hospital, you are covered with no daily coinsurance. For days 61-90 of a hospital stay, coinsurance is $400 per day. For days 91 and beyond, coinsurance for each âlifetime reserve dayâ after day 90 is $800. With a skilled nursing facility, coinsurance is $0 for the first 20 days of each and $200.00 per day for days 21-100. To find out where you are in your benefit period, refer to your Medicare Summary Notice (MSN). This document details all health care services you received in the past 3 months.
References:
https://www.medicare.gov/glossary/b.html
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
https://blog.medicarerights.org/what-is-a-benefit-period/Â
MUC63-2017-BCBS
SSI Blog
Many Illinois seniors do not realize that coverage and benefits change yearly with Part C plans, or fail to review the Annual Notice of Change before Annual Enrollment.
Review Coverage
As a member of Part C, each fall, you should receive an Annual Notice of Change. This document includes information about changes to your plan that will take effect the following January. Changes to your premium, deductibles, copayments, prescription, and network providers. Your maximum out-of-pocket limit may be reduced. This is your opportunity to review your coverage and decide if your plan still meets your needs.
Benefit Changes
Small changes can have a significant impact on your coverage and benefits, how much you pay out-of-pocket, and where you can go to receive services. Review network changes that may affect the doctors and hospitals you use. Your planâs medication formulary may cover fewer medications next year. Itâs a good idea to review the list carefully to ensure the medications are on the list and still available, and the pharmacy you use. Look for changes in how much you will need to pay to continue receiving the prescriptions you use regularly. Itâs also important to review network changes that may affect the doctors and hospitals you use for your medical care.
Different Plans
There are many different Part C plans, some with prescription benefits included, and some without. HMOs and PPOs are not required to offer prescription benefits. If you choose this type of plan that does not offer coverage, you may not join a separate Part D plan. Plans must send an Annual Notice of Change no later than September 30, a couple of weeks before the start of Open Enrollment. If you donât receive it, contact your plan administrator or agent. Details on how to request the notice can be found on the back of your membership card. If you decide to keep your plan, you donât need to do anything at all and you will automatically be re-enrolled in your plan for another year.
Options
Most plans do include benefits for prescription drugs, but no two plans are alike. It makes sense to find the one that fits your prescription needs best. If you take specific medications, compare plans by looking at the drugs that are included on the formulary, and be sure to identify which tier or tiers they are assigned to, how much they cost, and what pharmacies are in the network.
References:
Annual Notice of Change: https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html
MUC47-2017-BCBS
