Medicare Seeks To Cut Number Of Seniors Denied Nursing Home Coverage After Hospital Stays

From Kaiser Health News: (click for full article)

Concerned that a growing number of seniors have been unexpectedly forced to pay thousands of dollars for nursing home care after a stay in a hospital, Medicare has launched a pilot project to test whether relaxing its hospital payment rules could help beneficiaries.

The issue revolves around what should be an easy question: Is the Medicare beneficiary an inpatient? Although many seniors stay in the hospital for several days and are in a regular hospital room while being treated, they may be classified as observation patients, which is considered outpatient service.

That can be costly for seniors. Under Medicare rules, they must have at least three days in the hospital as an inpatient – not just for observation -- to qualify for Medicare coverage follow-up care in a nursing home.  In addition to generally higher hospital co-payments, observation patients can be billed any amount by their hospital for the routine, maintenance drugs they need. Some have reported charges of $18 for one baby aspirin and $71 for one blood pressure pill that costs 16 cents at a local pharmacy.

This may all come as a surprise since hospitals don’t have to tell Medicare beneficiaries they are in observation care.