Guide for Medicare Beneficiaries on Observation Status

Medicare beneficiaries who are admitted to a hospital and then discharged to a nursing home have been getting charged for care they thought Medicare would cover. A new self-help packet from the Center for Medicare Advocacy explains how beneficiaries can fight for the coverage they need.

The problem arises if a hospital places you in “observation status" instead of formally admitting you. Observation status triggers Medicare Part B, a part of the Medicare law that does not pay for post-hospital care. Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient (Medicare Part A) for at least three days. Spending time at the hospital under observation status does not count toward these three days because you are technically an outpatient, even if you slept at the hospital and underwent tests. As ElderLawAnswers previously reported, due to cost pressures from Medicare, hospitals often keep patients in observation status for days.

The Center for Medicare Advocacy has released a self-help packet that explains observation status and its potential impact on your coverage.  The packet provides a step-by-step guide to how you can best advocate for yourself at each stage of the process. The first step is to find out what your status is. If you are under observation status, you can try to get this changed while you are still in the hospital. If that doesn't work and Medicare denies payment for subsequent nursing home care, you can appeal the decision.

The packet lays out exactly what information you should ask for along the way to best build your case for a status change. Following the instructions in the packet will help you navigate the complex, sometimes lengthy process of trying to get your status changed from “observation” to “inpatient” so that Medicare will pay for your post-hospital care.

For more information about Medicare observation status, read this article.