Why Your Medicare Patient Status Matters Health insurance can be confusing, and unfortunately, it can get more complicated with age. In fact, there’s a new point of dispute under the Medicare system that seniors need to be aware of when seeking medical attention. Medicare claims that inpatient status begins when a senior is formally admitted to the hospital under a doctor’s order. Outpatient status is when the doctor has not ordered inpatient status, and can include emergency department services, observation services, outpatient surgery, lab tests, X-rays, and other various hospital services. To be covered under Medicare Part A, a senior has to receive three consecutive days of medical treatment as a hospital inpatient. This covers the full cost of skilled nursing for the first 20 days, and other associated costs up to 100 days. However, if they do not spend three consecutive days as an inpatient, and are instead treated as an outpatient, including being on “observation status,” they would be covered under Medicare Part B. Observation Status Can Mean Out-of-Pocket Expenses This scenario could mean out-of-pocket expenses, and unfortunately, if the senior is on observation for a long period of time without realizing, it could be a very expensive stay. According to an AARP report, two-thirds of observation patients are obligated to pay substantial costs, and 10% of observation patients paid more than if they had been admitted as an inpatient. A recent New York Times article stated, “Patients can be hospitalized for days, can undergo exams and tests, can receive drugs—without ever officially being admitted to the hospital. Instead, they’re 'under observation,' which means they’re outpatients, not inpatients. That can bring financial hardships—including lack of coverage for subsequent nursing home care.” NOTICE Act Helps Keep Patients Informed In 2016, the NOTICE Act (Notice of Observation Treatment and Implication for Care Eligibility) was passed, requiring hospitals to notify patients both orally and in writing when they are not inpatients, but are instead under observation. Hospitals are obligated to inform patients no later than 36 hours after they begin to receive observation services, and the written notice must explain that the patient is not an inpatient. Although currently there is no way to appeal observation status, there is some light at the end of the tunnel for anyone who has already encountered this financial predicament. In July 2017, a class action lawsuit was filed to appeal observation charges incurred by hundreds of thousands of Medicare beneficiaries after January 1, 2009. The Center for Medicare Advocacy, Inc. and the law firm of Wilson Sonsini Goodrich & Rosati will act as the class action counsel. In addition, as a Medicare beneficiary, seniors do have specific rights regarding their care, including the right to: Have questions about Medicare answered Understand all treatment choices Make a decision about, obtain a review, or appeal health care payment, services, or prescription drug coverage File complaints or grievances about the quality of care At this time, the best course of action is to be informed. If a senior seeks medical attention at a hospital, being aware of the observation status and understanding what financial implications it could encompass is half the battle. For more information about Medicare Part A and Part B coverage, contact 1-800-MEDICARE (1-800-633-4227). The Center for Medicare Advocacy also offers online resources, including a fact sheet and FAQ section. Read more: Why Your Medicare Patient Status Matters | Investopedia https://www.investopedia.com/advisor-network/articles/why-your-medicare-patient-status-matters/#ixzz5AaHrT8Na Follow us: Investopedia on Facebook
