Benefit periods are an important element of insurance coverage. In this article, we’ll define the term “benefit period” and explain how it relates to nursing home abuse.

Key Takeaways

• A benefit period is the length of time an insurance policyholder can receive payments from their insurer
• Longer benefit periods usually have higher premiums
• Sometimes there will be a waiting period before the beginning of a benefit period during which an insured person cannot be paid benefits
• To continue benefits uninterrupted, a policyholder must pay the premium for the next term before their current benefit period expires 
• The benefit period for Medicare coverage of nursing home stays is 60 days paid in full and 30 more days with a copay
• To be eligible for a new benefit period, a patient must remain out of the nursing facility for 60 days in a row

What Is a Benefit Period?

A benefit period is the length of time that an insurance policyholder or their dependents can file and receive payments for a covered event. The longer a policy’s benefit period, the more expensive the premium is likely to be.

Benefit periods usually begin when an insurer accepts the first premium payment, whether it be an installment or in full. However, sometimes benefit period only begins after a waiting or elimination period. During this probationary period, no benefits will be paid.

Toward the end of a benefit period, an insurer will notify the policyholder of the cost to renew their coverage. In order to continue benefits uninterrupted, the policyholder will need to pay the premium for the next term before the current benefit period expires. 

Common Benefit Periods

Benefit periods for common types of insurance are as follows:

• Disability insurance - As short as two years to as long as until the insured reaches age 67. Disability insurance usually requires a waiting period before the benefit period begins of 30 to 90 days for short-term policies or one year for long-term policies. 

• Health insurance - Benefit periods for individual health insurance are usually one year. Group plan benefit periods typically continue as long as the employer continues to pay premiums. A new health insurance plan may require a waiting period before the benefit period begins. 

• Homeowners insurance - Usually one year benefit period with 30 to 90 days before coverage goes into effect. 

• Automobile insurance  - Usually one year benefit period with some states imposing waiting periods before a new policy goes into effect.

Benefit Periods and Nursing Home Abuse

For nursing home Medicare benefits, the benefit period is 60 days paid in full and 30 additional days paid with a daily copay. The benefit period begins the day a patient is admitted to a hospital or to a skilled nursing facility and ends the day they have been out of the hospital or nursing facility for 60 days in a row. 

To be eligible for a new benefit period, a patient must remain out of the hospital or nursing facility for 60 days in a row. 

If a person needs to stay longer than 90 days in a nursing home, Medicare covers an additional 60 additional lifetime reserve days with a daily copay. These days are nonrenewable and will not be available even if the individual becomes eligible for another benefit period. 

All patients in nursing facilities and their loved ones are encouraged to be aware of the risk of nursing home abuse, or intentional harm or injury caused by nursing home staff. If you or somebody close to you has been a victim of nursing home abuse, you may be eligible for compensation for your losses. Speaking to an experienced nursing home abuse attorney will help you determine next steps.