When Hospitalized, the Importance of Being an Inpatient for Medicare Coverage

July 27, 2013 - PRLog -- Are you coming out of the hospital but you need weeks of rehab before you can go back to your home?  It's important to know the rules for that hospital stay in order to ensure you are covered for your rehab.  

This particular topic applies to people of all ages, no matter where you live, however, you can learn more about saving money and all issues relevant to New York State residents age 60 plus at http://seniorbenefitsguide.com.  

The rule is:
When you need to go to rehab or a Skilled Nursing Facility after a fall, illness or other medical condition, Medicare will cover 100% of the cost of your rehab stay for up to 20 days–as long as you’ve spent at least 3 days in the hospital as an "inpatient", not including the day you are released.  

The importance of being an "inpatient" cannot be overstated.  Most people focus on those 3–(actually 4, when you count the day of discharge), days you need to be hospitalized–and they pay no attention to the phrase “as an inpatient.”  Then they get a bill for thousands of dollars, and have no clue why Medicare won’t pay.

Protect Yourself:
Beware of a new trend happening now when people–usually seniors– are admitted to the hospital. Hospitals tend to admit them for "observation". This allows them to escape penalties if they have released you too soon and you have to be readmitted within 30 days.  If you are admitted as an "inpatient" and you need to return to the hospital two weeks later, the hospital is on the hook as far as Medicare paying out.  If they just designate you as under "observation" and you need to return, they are covered.  

Here's the scary part:  
You won't automatically know your designation when you are admitted to a hospital.  No one puts a big sign over your head: You will get the bed, hospital gown, level of care and tests.  The difference is Medicare only pays for your rehab if you were admitted an "inpatient."

So what should you do every time you or a loved one is hospitalized?
Right away, ask for your status.  Ask the doctor who admitted you, or your parent, what your (or your parent’s) designation is. If it’s for "observation", you’ll want to try to have your status switched to "inpatient" while you are still there.  Once you’re released into rehab, it’s too late.  

How do you do this?
Review your (or your parent’s) entire medical history with the doctor, including past illnesses and conditions and make sure he or she notes it all in your record.  A more complete, fleshed out profile of your health and risk factors could help you meet inpatient guidelines. Then ask your doctor get in touch with the hospital review committee and explain what conditions you have, or your parent has, that require a higher level of care.  Essentially you are asking them to designate you an "inpatient" because you have other issues they should know about.

If your efforts fail, and you are not switched to inpatient status and you can’t afford to go to a nursing facility, which can be almost $1,000 a day out-of-pocket, talk to the hospital’s discharge planner. Medicare covers a limited amount of at-home help, even if you weren’t an inpatient.  

But the point is to do whatever you can before you leave the hospital; and keep in mind that if your status is switched from observation to inpatient, you will need to be at that "inpatient" status for 3 full days, not counting the day of discharge to get Medicare-covered rehab.

To learn more about your rights, especially if you are age 60 and over and living in New York State, please visit http://www.seniorbenefitsguide.com.