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Medicare covers less when a hospital stay is an observation, not an admission
An increasing number of seniors who spend time in the hospital are surprised to learn that they were not “admitted” patients — even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs. Because they were not considered sick enough to require admission but also were not healthy enough to go home, they were kept for observation care, a type of outpatient service….Read More
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The Washington Post article to which you link is a confusing explanation of the Medicare observed vs. admitted issue. First, its (and your) headline is wrong: Medicare often – maybe most often – pays more when observed because most observations are overnight with no tests (Medicare pays 80% of the room fee when under observation vs. the room fee minus $1216 if admitted). Second, since most Medigap policies pay either the $1216 deductible if admitted or the 20% co-pay if observed (and because 95% of people on Medicare have some kind of supplemental), this is all much ado about nothing. Whichever way the claim is paid; Medigap pays the difference. Third, being observed vs. being admitted has nothing to do with being sick or healthy.
Finally the issue with getting subsequent care at a skilled nursing facility only after being admitted for three days is obviously related to the observed vs. admitted issue but it’s off on a whole other tangent having to do with holding down Medicare fraud. (So ask yourself whether the number of observations “shot up” as WaPo claims or did the accounting of such visits just become more accurate?).
But I agree that rule should be changed so that you can get skilled nursing care if medically needed – as covered by Medicare without ever going to an acute care facility.This is a very confusing explanation of the Medicare observed vs. admitted issue even by Kaiser Health’s low standards. First, the headline is wrong: Medicare often – maybe most often – pays more when observed because most observations are overnight with no tests (Medicare pays 80% of the room fee when under observation vs. the room fee minus $1216 if admitted). Second, since most Medigap policies pay either the $1216 deductible if admitted or the 20% co-pay if observed (and because 95% of people on Medicare have some kind of supplemental), this is all much ado about nothing. Third, being observed vs. being admitted has nothing to do with being sick or healthy.
Finally the issue with getting subsequent care at a skilled nursing facility only after being admitted for three days is related but off on a whole other tangent having to do with holding down Medicare fraud (Ask yourself: did the number of observations “shoot up” as WaPo claims or did the accounting just become more accurate?). I agree that rule should be changed so that you can get skilled nursing care if medically needed – as covered by Medicare — without ever going to an acute care facility (never mind for three days). But that does not mean you can cheat and get custodial nursing care by going to a hospital first and getting admitted for three days.