Something Important to Know if You’re on Medicare and Need to Be Admitted to the Hospital from the ER

If you're being kept overnight in the Emergency Room (ER) or admitted to the hospital on Medicare, the first question you need to ask is: "Am I being admitted as an inpatient or am I under observation?"

It sounds like the same thing — you're in a hospital bed either way — you’re receiving care either way. However, the difference can cost you thousands.

Under observation status, you're technically an outpatient. That means:

• Medicare Part B covers your care, not Part A

• You pay 20% coinsurance on every service with no cap

• Days spent under observation don't count toward the 3-day inpatient stay required for Medicare to cover a skilled nursing facility or rehab afterwards

• Prescription drugs aren't covered the same way

You can be under observation for days and never know it unless you ask.

Here's what to do:

When you're admitted, ask your doctor or the hospital staff directly whether you're inpatient or observation. If you're under observation and you think you should be admitted as an inpatient, you can ask for a review. You also have the right to appeal through a Quality Improvement Organization (QIO). Ask to speak with your case manager. Or Pick up the bedside phone and dial O for the hospital operator. Ask him/her to connect you to the Nurse Manager on duty, or to the Medical Officer on duty or to the hospital chaplain.

If you’ve been under observation, get it in writing if possible — check your hospital notices and your Medicare Summary Notice after discharge for your rights.

This is one of the most confusing parts of Medicare, and it catches people off guard every day.