Medicare
Observation or inpatient? Why it can change what Medicare pays after a hospital stay
Being kept overnight in the hospital can mean either inpatient or observation status. Under Original Medicare, skilled nursing facility coverage generally requires three days as an inpatient, and observation time does not count toward them.
Why it matters
- Inpatient care is billed under Part A, and observation under Part B, with different cost-sharing.
- Skilled nursing facility care after a hospital stay generally needs a qualifying three-day inpatient stay under Original Medicare.
- Some Medicare Advantage plans waive the three-day rule. Ask your plan.
What you can do
Ask the hospital, early, whether you are an inpatient or under observation, and why. Hospitals are required to give written notice if you have been receiving observation services for more than 24 hours.
If you were told you would go to a skilled nursing facility next, ask how your status affects it before you leave.
Have this ready when you call
- Your hospital paperwork
- Your admission and discharge dates
- Your plan card
- The skilled nursing facility's name, if any
Common questions
Can I appeal an observation decision?
There are limited ways to ask for a review, and the rules are specific. Keep your paperwork and ask for help early.
Does my supplement help?
A supplement covers cost-sharing for care Original Medicare covers. It does not change whether Medicare covers it.
Related answers
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