If you are in a hospital bed, are you considered as being “admitted” to the hospital and covered under your Medicare Part A? The answer might be surprising and costly. Don’t assume. Ask.
When you go to the hospital, knowing whether you’ve been admitted as an inpatient or put on observation status is highly important to you financially. Here’s why…
Inpatient vs. Observation Status
Your hospital status (whether the hospital considers you an inpatient or outpatient) can affect you in 2 ways:
- How much you pay for hospital services (like X-rays, lab tests, etc.), and
- Whether Medicare will cover care in a skilled nursing facility following your hospital stay.
Your hospital status (admitted inpatient vs. observation care) is a medical decision based on your doctor’s judgment and your need for medically necessary care.
You’re an inpatient when you’re formally admitted to a hospital with a doctor’s order.
As an inpatient, Medicare Part A (Hospital Insurance) covers your hospital stay and some services. Under Medicare Part A, you are responsible for a one-time “benefit period” deductible for your hospital stay during the first 60 days you are in the hospital.
Medicare Part B (Medical Insurance) covers most of your doctor and non-nursing care medical services when you’re an inpatient.
Having Medicare supplement insurance can help cover those out-of-pocket costs. If you have a Medicare supplement, the amount you pay (or lack thereof) for doctor services will depend on which plan type you have. If you do not have a Medicare supplement, you’ll pay 20% of the Medicare-approved amount after you pay the Part A and B deductibles.
You’re in observation (outpatient) status if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor has not written an order to admit you to a hospital as an inpatient. Observation services are hospital outpatient services given to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged.
As surprising as it may seem, you might still be considered an outpatient under observation status even though you may stay in the hospital for several days and receive treatment in a hospital bed.
Medicare Part B covers your outpatient (observation status) hospital services. Generally, this means you pay a copayment for each individual outpatient hospital service. Part B also covers most of your doctor services when you’re a hospital outpatient. If you do not have a Medicare supplement, you’ll pay 20% of the Medicare-approved amount after you pay the Part B deductible. If you do have a Medicare supplement, the amount you pay (or lack thereof) for doctor services will depend on which plan type you have.
What Hospital Status Means for You
Medicare will only cover care you get in a skilled nursing facility if you have had a “qualifying inpatient hospital stay,” meaning you’ve been a hospital inpatient for at least three days in a row (counting the day you were admitted, but not counting the day of discharge). Observation outpatient stays, regardless of length, do not count toward Medicare’s requirement.
In light of this, it is extremely important that you be admitted to a hospital for a minimum of three consecutive nights if you feel you might be referred to a skilled nursing facility following your time in the hospital. Your rehabilitative care in the skilled nursing facility will not be covered if you have not been a qualified inpatient in the hospital for three consecutive nights.
Tips to Avoid Big Bills
If you or a loved one is in the hospital, be sure to ask the following questions upon entry and each day while in the hospital:
- Is the patient’s hospital status inpatient or outpatient?
- How long will the patient’s hospital stay be?
- Will there be a need for specialized skilled care or rehabilitative care after the patient is discharged?
The answers to these questions can help you potentially avoid expensive and unexpected medical and rehabilitative bills that otherwise could have been covered by your Medicare Part A, Medicare Part B, and Medicare supplement policy (if you have one).
As always, if you have any questions, please feel free to ask in the comment section below!
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