When your elderly parent is in the hospital, you need to know with 100 percent certainty if they were actually admitted or not.
Even if a patient spends the night in the hospital, that doesn’t guarantee they were admitted. They may have been kept on observation status. And hospital status matters because it affects how much you pay, not only for hospital services but also for follow-on care in a skilled nursing facility (rehab).
According to www.medicare.gov,
“You’re an inpatient starting when you’re formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
“You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient.”
You can stay overnight, several nights even, at the hospital and not be an inpatient.
And here is what is covered depending on your status (NOTE: This is a general overview and not intended to be comprehensive or used as a payment guide. Visit www.medicare.gov for more information and check with your insurance provider.)
Medicare Part A covers inpatient hospital services, most likely after a deductible is met and up to a certain period of time. Medicare Part B covers a portion of doctor services for inpatients after a deductible is met. More info here.
Patients must be classified as inpatients for 3 days in the hospital in order for Medicare to pay for subsequent nursing home care.
Medicare Part B covers outpatient hospital services. You typically pay a copayment for each individual outpatient hospital service. Also over-the-counter drugs aren’t typically covered by Part B for outpatients. More info here.
Here is a handy guide to observation status from the Center for Medicare Advocacy.observation-status-infographic
You might also like: