Update: Observation status

Posted: June 4th, 2015 | Author: Elizabeth H. Klampert Blog
Categories: Medicare

I have addressed this vexing issue previously but it still has not been resolved.  The issue is that hospitals are often not actually admitting Medicare patients, but putting them under “observation.”  Most people are aware that, for Medicare to cover their Part B expenses for rehab stays, their hospital stay must be for at least three days (or “two midnights”).   However, for this to happen, they must actually be “admitted” to the hospital.

If patients are on “observation status”, they have not been admitted to the hospital and, if after discharge they go to a rehab facility, Medicare will not cover their stay in the facility.  This means that Medicare patients, often unwittingly, find themselves facing large bills that they must pay themselves. While New York State, among others, now requires hospitals to advise patients within 24 hours that they are being placed on “observation status,” efforts to change this at the national level have not yet succeeded.

In 2015, both houses of Congress once again reintroduced bills to rectify this situation.  In the House, Rep. Joe Courtney (D-CT) has introduced H.R. 1571, Improving Access to Medicare Coverage Act of 2015.  In the Senate, the same bill, S. 843, was reintroduced in the Senate by a bipartisan group of senators, Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL), and Shelley Moore Capito (R-WV).  These bills would require that all days spent in the hospital count toward the three-day requirement for Medicare Part B coverage, whether deemed admitted or on “observation”.

What can concerned Medicare recipients and their families do to help?  While GovTrack.us rates the chances of this legislation being enacted at “0%” (as it has done for the past three years), they can contact their Representatives and Senators to encourage them to support this legislation.


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