ABC&D's of Medicare

General Information


Health - General

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The ABC&D’s of Medicare

by Timothy Lorenz, an Independent Insurance Agent,

serving the Senior Community of Sheboygan County

Inpatient or Outpatient?

At a recent meeting, a serious issue with regard to hospital

inpatient status was discussed. It was brought to our attention that

a hospital overnight stay may be considered “outpatient” services

instead of “inpatient”. Hospital status affects how much you pay

for hospital services and will affect whether you will qualify for

Skilled Nursing Facility (SNF) care.

Inpatient admission begins the day you are formally admitted to

the hospital with a doctor’s order and ends the day before you are

discharged. The important word here is order; without a doctor’s

order you will not be considered inpatient. Outpatient care can

include a variety of medical services, including: emergency care,

out-patient surgery, lab tests, X-rays and observation.

Observation is considered outpatient care and lasts for a short

period of time, but not always. At the meeting, there were reports

of observation stays for up to 3 days! Three days of observation

care will not qualify you for SNF care and the financial impact

to a senior who may require SNF care after a medical event is


Inpatient care is covered under Part A of traditional Medicare. If

you have a Medicare Supplement plan with a “Part A deductible

rider,” you are financially covered. Outpatient Care is covered

under Part B of Medicare and a supplement plan will cover all

costs if you have the “Part B deductible rider” and “excess charge


The inpatient / outpatient issue can be a serious financial issue

with people enrolled in Medicare Advantage plans. Observation

is generally considered Outpatient Surgery. I prefer Medicare

Advantage plans that specify fixed dollar copays instead of

percentages. You need to know how your Advantage plan handles


Drug coverage while under observation can become another

serious issue, especially if you are there for more than one day.

Most medical facilities will not let you take self-administered

drugs from home while under observation care. The costs of these

medications are not covered under Part B of Medicare, Medicare

Supplement or Advantage plan.

Being admitted for a Part A hospital stay requires a doctor’s order

and a 3-day hospital stay fulfills the requirement for skilled nursing

care. Outpatient care, Part B is generally a short term event that

could lead to a longer stay. The longer stay could be a covered

Part A hospital stay if you are properly admitted to the hospital;

otherwise it could be billed as observation. Ask your doctor or the

hospital staff if you are inpatient or outpatient. Did they formally

admit you if an outpatient medical procedure extends more than

12 hours? Finally, doctors and hospitals have to follow Medicare

regulations. You can find more information in Medicare and You

for 2017 or at the Medicare website.

To learn more about Medicare and your Medicare options and the

ACA, you can call me at 920-457-2911 (Home) or 920-287-5302

(cell) or stop by at 2708 N 7th St., Sheboygan W 53083.
Keywords Sheboygan County, Independent Insurance, Senior Community, Agent serving, Timothy Lorenz, Insurance Agent, prescription drug, Medicare Advantage, health insurance, Election Period, health care, Medicare Supplement, Medicare Prescription, Initial Election, Medicare Fraud
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