Just because your family member is in a hospital bed, on a hospital unit, eating hospital food, and undergoing hospital tests does not mean they are automatically admitted to the hospital. Sometimes doctors want to “observe” a patient for a few hours and more hospitals are observing a patient rather than having them admitted.
A few things a person should know about admission vs. observation:
- Hospital admissions are covered under Medicare part A. Under Medicare Part A, after a one-time deductible fee, all hospital costs are covered when a person is admitted as an inpatient.
- Observation status or emergency room care (without admission) are considered outpatient care and are only covered by Medicare Part B. Medicare Part B treats each lab test, x-ray, and other services as individual items, each with a co-pay. Prescription drugs are not covered and may be a separate charge.
- To be eligible for Medicare-covered skilled nursing facility services, the patient must have a hospital inpatient stay for at least three days. The observation period does not count.
Ask repeatedly if your family member has been officially admitted to the hospital, or if he/she is under observation status.
Make a note of each staff person’s response including their name and date.
The hospital can retroactively (after the fact) change the patient’s status from inpatient to outpatient. This change is supposed to be made while a person is in the hospital, with written notification to the patient.
This information was provided by www.nextstepincare.org. Please contact Herkimer County Office for the Aging or NY connects for more information at 315-867-1415 or www.herkimercounty.org go to departments then Office for the Aging.