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Observation vs. Admission Status for Seniors upon Hospitalization: Know before you go

August 29, 2011

Federal regulations have changed the hospital admission procedure for Medicare recipients. Hospitals are required to admit Medicare patients under the “observation” status while patients receive full medical treatment in a hospital bed. This status can be longer than 48 hours and generally without the patient’s knowledge.

What this means to you
• Medicare recipients are billed for 20% co-payments and full prescription costs when admitted to a hospital under “observation.” More money out of your pocket to pay for hospital care that should be covered by Medicare Part A.
• Medicare will not cover a skilled nursing facility (SNF) if there is less than three consecutive days of inpatient care (not counting the date of discharge). You will be responsible for the cost of a SNF, with an average cost of $350/day.
• Medicare has increasingly denied admission for inpatient status.
• You lose your right to appeal Medicare denials.

Solution – Passage of proposed US Legislation: S. 818 and H.R. 1543, the “Improving Access to Medicare Coverage Act of 2011.”
• Amends the Medicare statute’s definition of “post-hospital extended care services” to include observation status as inpatient in the hospital, thereby covered under Part A.
• Alleviate the problem of shifting costs to the beneficiary and hospital.
• Prevents poor care and frequent readmissions.
• Retroactive beginning January 1, 2011 but beneficiaries must appeal within 90 of enactment.

Contact and demand that the CT delegation co-sign the bills and request them to persuade other state delegations to do the same. (Contact information on back).

Congressman Joseph Courtney (Sponsor of HR.1543)
Washington             Norwich                    Enfield
202-225-2076         860-886-0139         860-741-6011

Congresswoman Rosa L. DeLauro
Washington           New Haven           Middletown          Naugatuck              Derby
202-225-3661       203-562-3718       860-344-1159       203-729-0204       203-735-5005

Congressman Christopher Murphy
Washington           New Britain           Meriden                 Danbury                     Waterbury
202-225-4476       860-223-8412       203-630-0815       203-798-2072          203-759-7541

Congressman James Himes
Washington                   Bridgeport/Stamford
202-225-5541               866-453-0028

Congressman John Larson
Washington                  Hartford
202-225-2265              860-278-8888

Senator Joseph Lieberman                                                     Senator Richard Blumenthal
Washington              Hartford                                                 Washington                     Hartford
202-224-4041          860-549-8463                                       202-224-2823                860-258-6940
Web     Web

Caring Families Coalition is a nonpartisan advocacy coalition that unites groups, families, and individuals, and encourages collective action to improve or protect health care. We provide members with information, trainings and opportunities to advocate for positive change. CFC does not sell health care products or accept money from health care companies.

For more information, please contact:
Eva Csejtey, CFC Organizer Sarahí Almonte, CFC Organizer
860.230.5008 or 860.524.0502 or

This information was provided by a panel on Observe Vs. Admit – The New Limbo Land for Hospital Patients with Medicare, sponsored by Senior Resources – Agency on Aging.

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