Observation Status

Did you know that you could go to the ER for chest pains, stay in the hospital for 2 nights- and Medicare Part A  might not cover your expenses? If you are not admitted the hospital (meaning you have been put on ‘observation status’) than your coverage is different than if you had been actually admitted as a patient.

This is an important distinction that many people need to be aware of! Whenever you go to the hospital, be sure to ask DAILY if you are considered inpatient or outpatient. Just because you have spent the night (or several nights) in the hospital DOES not mean you have been admitted as an inpatient.

Let’s say for example you go to the hospital for an outpatient procedure- while you are there, your blood pressure spikes and the doctor decides to keep you overnight to keep an eye on things. This does NOT mean you have been admitted to the hospital, and Medicare Part A will not pay for any of the expenses incurred during this hospital stay.

Even when your primary care doctor writes an order for you to be inpatient, don’t assume that you are admitted. The hospital can still make the decision to put you on observation (outpatient). In this type of situation, the hospital must inform you in writing of this change. Be alert for any paperwork that you receive while in the hospital.

There are a few reasons why inpatient versus outpatient is so important- namely because the cost of services while you are in the hospital will vary depending on your status. X Rays, Lab work, even prescription costs will be different depending on whether or not you are admitted or under observation.

Another very important reason to make sure you are actually admitted to the hospital is because if you need to go to a Skilled Nursing Facility after being in the hospital, medicare part A will only cover your expenses after a 3 day inpatient hospital stay. The daily rate at a SNF is

  • Days 1–20: $0 for each benefit period.

  • Days 21–100: $152 coinsurance per day of each benefit period.

  • Days 101 and beyond: all costs.*

*Keep in mind that you can receive custodial care in the privacy of  your own home for about the same price. Call Capability Homecare today to learn more. 425 679 5770.

For more information about Medicare and what is covered, click here!


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