The New York Times article “ noted: “ But it turns out that even though you are receiving treatment in a hospital bed, you may simply be under observation, and technically are still an outpatient. That can cost you money if you are covered under Medicare, the federal health plan for older Americans.”
“The distinction between inpatient and outpatient care is important: Medicare pays different rates accordingly. And official admission or outpatient status also affects eligibility for additional Medicare coverage, should follow-up care in a nursing home be required. Regardless of length, observation stays do not count toward Medicare’s requirement that to be eligible for subsequent rehabilitation services at a nursing home, a patient must have a hospital stay of three consecutive days — three “midnights,” specifically. Otherwise, rehabilitation care may not be covered, making it an out-of-pocket expense.”
Observation status alone may cost you more money. Medicare Part A covers patients who are formally admitted to a hospital, with a one-time deductible. Medicare Part B, which covers outpatient care, applies to the stays classified as observation. Services like laboratory tests, X-rays and EKGs are billed separately, and generally you will have a charge for each one. While the payment for any single Part B service cannot be more than the inpatient deductible, the total of all payments for Part B services may be higher, according to the Families and Healthcare Project of the United Hospital Fund. Prescription drugs are not covered, either. And for those who have chosen not to have Medicare’s Part B coverage, the bills could be quite large. “Each charge is separate,” said Carol Levine, the project’s director, “and it adds up.”
“Here are some questions about observation stays:
- How do I know if I’m an inpatient, or an outpatient, when I’m being treated at a hospital?
- What can I do if I find that I am being treated under “observation” status, rather than as an inpatient?
- Where can I get more information about appealing charges?
Click here to read the full NYTs article “When a Hospital Stay Is Not a Stay” by Ann Carrns.
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.