The Hospital Surprise You Don’t Want to Get Under Medicare
You are in a hospital room, you are sick. Nurses check on you regularly and give you medicine. Your doctor has ordered treatments but you have Medicare so you figure you won’t face a hefty bill. Well, surprise. You learn you haven’t been admitted to the hospital. Instead you are receiving Observation Care. That means doctors have decided you won’t be staying more than two midnights. Your doctors and nurses are monitoring your condition and watching to see if you need to be admitted but often patients can’t see any difference in care. Observation patients are considered too sick to go home yet not sick enough to be admitted. Medicare considers Observation Care an outpatient service even if you stay overnight at the hospital so you will likely have more hospital costs than if you had been admitted. You will incur costs like a coinsurance Medicare charges for outpatient care, generally 20% and the bill for the drugs you may need for your chronic conditions. Generally, prescription and over-the-counter drugs, including 'self-administered drugs,' given to you by the hospital in an outpatient setting are not covered by Part B.
So here’s a comparison; that baby aspirin you take for your heart condition, it could cost $18 at the hospital instead of the pennies you are used to paying when you buy it at the big box store and because Medicare has no limit on out-of-pocket charges, it call all add up fast. The price tags could be even higher if you go to a nursing home after leaving the hospital. Medicare will help pay for the expensive nursing home care only if you spent at least 3 consecutive days in the hospital as an admitted patient. Observation Care doesn’t count on that clock.
Nearly 2 million Medicare patients received observation care in 2014, that’s a spike of 103% since 2006 and 5% more than 2013, according to government statistics. Complaints about Observation Care prompted Congress to pass the Notice Act. Under the law, the Notice Act must explain the reason the patient has not been admitted and how that decision will affect Medicare’s payment for services and patients’ share of the costs. It does not change your financial responsibility. It requires that hospitals tell you that you are in Observation Care after 24 hours and what the costs might be.
For more information about Medicare and Observation care, please go to Medicare.gov. For more information or to contact Bethany Sullivan at Sullivan Health Care Solutions, please call 262-261-8027.