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What Is the Difference Between Inpatient and Observation Status?

If you’re in a hospital bed, are you “admitted” to the hospital and covered under your Medicare Part A? The answer: not necessarily. 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, and it can impact the care you’re eligible to receive after. Even if you stay in the hospital for a few nights, unless a doctor submits a written order admitting you, your stay is categorized as observation.  

How Does Observation Status versus Inpatient Status Affect Me?

You may be impacted in two ways depending on whether you’re in observation status versus inpatient care:

How Much You Pay for Hospital Services

Medicare bills you differently depending on your status as an inpatient. For example, Medicare Part A represents your inpatient coverage, and has a $1,408 (in 2020) deductible. Compare this to Medicare Part B, which is your outpatient coverage (including observation care) and only has a $198 (in 2020) deductible.

 If you have a Medicare Supplement plan, it’ll help with your costs, but depending on the level of coverage you have, you could still face bills. Medicare Supplement Plan G, for instance, covers all of the cost gaps except for the Part B deductible. If you aren’t admitted as an inpatient, you’d have to pay the Part B deductible.

Your Ability to Receive Care at a Skilled Nursing Facility

 Medicare will only cover care at a skilled nursing facility if you’ve been admitted to the hospital as an inpatient for at least three days. So, if you were in the hospital for three days under observation, Medicare won’t cover a skilled nursing facility even if your doctor recommends it.

When Would I be Under Observation?

Typically, you’ll be kept under observation status if you’re expected to need care over one night. Observation services are performed to help the doctor decide if you should be admitted as an inpatient or discharged. For instance, if you’ve had a severe allergic reaction and the doctor wants to monitor your vitals overnight, you may be kept under observation.

If the doctor hasn’t written an order for you to be admitted to the hospital, the services you receive will be categorized as observation, even if you could receive the same services as an inpatient. Treatment that you can receive while under observation includes outpatient surgery, lab tests, and X-rays.

As surprising as it may seem, you might still be considered an outpatient under observation status even if you stay in the hospital for several days and receive treatment in a hospital bed.

When Would I be Admitted as into Inpatient Care?

You’re admitted as an inpatient once the doctor submits a written order. You may receive some of the same care that you could receive if you were kept under observation, as well as other services like major surgery. You’ll most likely be admitted if your doctor expects you to need treatment at the hospital for two or more nights. A common situation in which you’d be admitted as an inpatient is you’ve suffered a heart attack, and need treatment or to be monitored closely.

How do I know if I’m an inpatient?

In some cases, you can ask what your status will be ahead of time. Total knee replacement surgery can be performed as an inpatient surgery or outpatient surgery, so you can discuss your needs with your doctor before your scheduled appointment. If you’ve arrived at the hospital for an emergency situation, you can always ask the doctor or staff what your status is. Once you’ve been under observation for more than 24 hours, you’ll also receive a Medicare Outpatient Observation Notice that informs you why you’ve been under observation instead of being admitted, and how it may affect your care and your bills.

Being in the hospital is stressful, and your status probably isn’t the first thing on your mind. However, because of the effect it can have on your bills and ability to receive skilled care, it’s important to know whether you’ve been admitted or are under observation. Talk with your loved ones so that if you’re ever in this situation, they’ll know what questions to ask, and can better support you during your treatment. 

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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