Medicare and Observation Status


Sometimes a senior goes to the emergency room and ends up being not quite sick enough to be hospitalized but too sick to go home. That situation is known as Observation Status. You are not admitted but put in a bed and kept under observation for up to several days. THIS IS A SITUATION THAT MEDICARE GOES NOT PAY FOR. Since Medicare won’t pay, your supplement or MAPD plan will not pay either.

Since Medicare won’t pay for the observation status and many hospitals aren’t telling that to the patients it has created a very uncomfortable situation for all involved. This is a very complicated situation and too much detail makes it even harder to understand.

CMS has chosen to require that all facilities must tell the patient in simple terms that Medicare won’t pay for observation status. This begins in July.

Prior to this recent change I have been telling my clients about observation status and telling them to tell the hospital admit me or I’m going home. Sometimes that doesn’t work due to the seriousness of the medical situation but does work on most cases.

Finally, CMS is doing something about this situation because hospitals have been charging large amounts to those that fall under this category leaving the patient holding the financial bag. This is a good thing for Medicare recipients.

Len Barend


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