When you are on Medicare, your hospital “status” affects what you will pay for hospital services and whether a skilled nursing facility will be covered on your discharge. When your physician formally admits you to the hospital, you have an “inpatient” status. You are in “observation” status until your physician writes the order to admit you, even though you may spend one or more nights in the hospital.
In “observation” status, you may be provided hospital services to help your physician determine whether you need to be admitted to the hospital as an “inpatient”. Those hospital services may take place in the Emergency Room, in a hospital room, or any other part of the hospital. It is common for patients that are in the hospital for more than a few hours and especially overnight, to believe they have been admitted. The safest way is to ask your doctor whether you have been admitted to the hospital or you are in observation status.
Depending on your status, Medicare coverage is very different. When you are an “inpatient” Medicare Part A determines what coverage you have. With Medicare Part A, your hospital coverage, you will pay a one-time deductible for all of your hospital services for up to the first 60 days. Medicare Part B, your medical coverage, will cover 80% of the Medicare approved amount for your doctor services after you pay your deductible.
However, when you are on “observation” status, Medicare Part B provides your insurance coverage, not Medicare Part A. Medicare Part B covers the hospital services, but you will have to pay a copay for each individual hospital service. The coverage for your doctor bills is the same on “observation” status as it is for “inpatient” status.
Furthermore, prescription and over-the-counter drugs you receive when you are on “observation” status are not covered under Medicare Plan B. If you have Medicare Part D, prescription drug coverage, these drugs may be covered in some situations.
Medicare will only cover a skilled nursing facility if you first have a “qualifying hospital stay.” A qualifying hospital stay is defined as having been on “inpatient” status for at least 3 consecutive days, counting the day you were admitted, but not the day you were discharged.
For more information, visit www.medicare.gov/publications
to view the “Medicare & You” handbook. You may also call 1-800-MEDICARE (1-800-633-4227).