Understanding Medicare Changes: Part 3 of 4

Hospital stays: what’s your status? The different between being under “observation” and being “admitted.”

Many of us have found ourselves in a hospital for one reason or another. Sometimes for a scheduled surgery, other times an emergency room visit, and sometimes even in an urgent medical situation brought in via an ambulance.

When you have a stay at a hospital, your doctor will mark your status as either under “observation” or have you formally “admitted” to the hospital. The difference, however, isn’t always clear. In fact, you may be under observation for days, sleep in a hospital room, in a hospital bed, and eat hospital food, but not actually be admitted as an inpatient.

It is important to know this status for a number of reasons, perhaps the most important of which deals with needing Skilled Nursing or Sub-Acute Rehabilitation after your hospital stay. If you are formally admitted to the hospital, and stay for three full days (not including the day you are released), Medicare will cover your rehabilitation in a skilled nursing facility.

However, if you spend those same three days (or more, or less) but your status is under observation, Medicare will not cover your rehabilitation should you need time in a skilled nursing facility.

To make sure you know your status, and to make sure you receive the coverage you need, it is important to have a discussion with your doctor and the social worker at the hospital. These are the people you can use as resources and advocates for your health and coverage.

During our recent “Medicare…What Now???” medical lecture, a Crane’e Mill resident noted the importance of a hospital liaison from a community such as Crane’s Mill. In our community’s case, we have a staff member named Barbara Davey whose main role is to visit our independent living residents in the hospitals, and work with their families, doctors and social workers to bring them back to the community for rehabilitation and ultimately, back to their independent living apartments and cottages.

For more information about Medicare, please visit www.medicare.gov or call 1-800-MEDICARE.

To find out more about Crane’s Mill, we encourage you to call 973-276-6700 or click here to contact us.