Medicare
Did you know that even if you stay in the hospital overnight in a regular hospital bed, you might still be considered an "outpatient"?
You are an outpatient if you're getting emergency department services, observation services, lab tests, or X-rays, and the doctor has not written an order to admit you to the hospital as an inpatient - even if you spend the night at the hospital. An inpatient admission begins the day you are formally admitted to the hospital by a doctor's order. Why is this important for you and your family to know? Your hospital status (whether you are considered an "inpatient" or "outpatient") affects how much you pay for hospital services (like X-rays, lab tests, and medications). And your hospital status may also affect whether Medicare will cover post hosptital services and care you may need in a skilled nursing facility (SNF).
- As an inpatient Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all your hospital services and Medicare Part B covers most of your doctor services. You will pay 20% of the doctor's services after paying the Part B deductible.
- As an outpatient Medicare Part B covers outpatient hospital and doctor services and you will pay a copayment for each individual hospital service and the doctor's services.
- Generally, the prescription and over-the-counter drugs you get in an outpatient setting like an emergency department are not covered by Part B. If you have Medicare Part D prescription drug coverage, these drugs may be covered under certain circumstances. Call your Part D plan for more information.
- Medicare will only cover care you receive in a SNF if you first have a "qualifying hospital stay". A qualifying hospital stay means you have been a hospital inpatient for at least 3 days in a row (inpatient stay must include 3 midnights). The qualifying hospital stay is important since SNF services, such as physical and occupational therapy, and/or speech therapy, are often needed after hospital discharge in order to ensure optimum recovery and a safe discharge home.
Be informed - Ask your doctor or the hospital staff if you are an "inpatient" or "outpatient" any time you spend more than a few hours in the hospital.
For more detailed information on how Medicare covers hospital services, visit www.medicare.gov/Publications/Pubs/pdf/10050/pdf to view the "Medicare & You" handbook. You can also call 1-800-Medicare (1-800-633-4227).
DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.
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