“Admission” Or “Observation” : Why Does It Matter?


Slide4Most of the posts on this blog, for this year, have been aimed at people who are confused by Obamacare.  A recent survey indicates that even though the PPACA has been law for over 3 years, over 40% of Americans are still confused.

In this post I want to deviate from the norm.  Any effect that Obamacare will make on people with Medicare happened 3 years ago.  With the exception of some provisions that affect Medicare D plans, all the changes to the Medicare system have already gone into effect.

All the recent talk about Obamacare and “Marketplaces” apply to Americans who are not yet 65.

If you have private health insurance, it typically makes very little difference whether you are formally admitted to a hospital or merely “held for observation.”  Your insurance is going to pay your bill the same way.

However, Medicare is much different.  There are two ways that hospitals treat people with Medicare.  If you, or a loved one, has to stay over-night in the hospital, you need to know how they list you.

ADMISSION

People, with Medicare, who are actually admitted to a hospital have their hospital bill paid under Medicare Part A.  That means that after you have paid a deductible, Medicare will pay 100 % of your hospital bill.  (Keep in mind that your doctors will bill separately.  Those bills will be paid by a different part of Medicare.)

There are 2 reasons why a hospital may not “admit” a Medicare patient.

  1. Under new rules from Obamacare, hospitals are penalized if they are required to readmit too many Medicare patients.
  2. Medicare will not pay the hospital anything if they have a medical reason the patient should not have been “admitted” but merely “observed.”

Also, to be considered  is that Medicare rules require a patient to be officially “admitted” to a hospital for 3 days before they will help with the cost of a nursing home.

OBSERVATION

While some hospitals will formally “admit” a patient another hospital may want to play with their Medicare numbers and only “hold patients for observation.”

When a hospital does this, the hospital bill is paid under a different part of Medicare.  Unless you have a good Medigap plan, you would have to pay 20% of the bill, with no cap on the amount you would have to pay out of your savings.

Also consider that patients who are treated as “observation” patients rather than “admitted” will not get help from Medicare if they need nursing home help after they get out of the hospital.

MORAL

If you require emergency medical treatment, you do not have time to quibble.  However, if you do have time to do some shopping, before you go into the hospital for non-emergency treatment, find out whether you will be formally admitted or merely held for observation.

It could save you hundreds of dollars out of your pocket.

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