The length and type of your hospital stay determines your eligibility for further care.
When you go into the hospital and spend the night, you might assume that you are an inpatient; after all, most outpatients just come to the hospital for a few hours and go home after treatment. That may not always be the case, however, and if you are a Medicare beneficiary, it is important to understand the distinction between inpatient and outpatient hospital care, and how it affects your benefits.
Definition
The 72-hour rule, more commonly known as the three-day rule, affects Medicare beneficiaries who go to the hospital, and then need skilled nursing care or rehabilitation services. In general, Medicare rules require that you spend at least three days, or 72 hours, as an inpatient in the hospital before you can be referred to a skilled nursing facility covered by Medicare. If you don't have the minimum three-day hospital stay, you may still be able to get care from a home health aide or veteran's hospital.
Determining Length of Stay
When you visit the hospital, you may still be considered an outpatient, even if you spend one or more nights in a hospital bed. Your inpatient stay begins when your doctor officially admits you to the hospital, and ends the day before you are discharged. For example, if you go to the hospital with chest pains, and spend a night in the emergency department under observation, that is considered an outpatient visit. If you are admitted to the hospital on the second day, that is considered the first day of your inpatient stay, and you must stay for at least 72 hours before being discharged for the stay to count toward the three-day rule.
Medicare Advantage and Supplement Plans
If you have a Medicare Advantage or Medicare supplement plan, the policy regarding minimum inpatient and outpatient stays can vary according to the plan. According to federal law, insurance companies that offer these types of plans must abide by Medicare guidelines, meaning that they cannot require patients to spend more than three days as an inpatient to qualify for skilled nursing care. However, many plans lower the minimum stay requirement, and some waive the requirement altogether.
Other Considerations
In addition to affecting your eligibility for skilled nursing services, whether you are an inpatient or an outpatient at the hospital services determines how much you have to pay for your care. Medicare Part A is hospital insurance, and covers your hospital inpatient services after you meet your deductible for the first 60 days of hospital care. If you are not admitted as an inpatient, your outpatient care is covered by Medicare Part B. You'll have to pay a co-payment for each individual service you receive in the hospital, plus 20 percent of the Medicare-approved doctor's cost after you meet the deductible. You'll also most likely have to pay out-of-pocket for any prescription drugs you receive as an outpatient, but you can request reimbursement from your Part D plan.
Tags: skilled nursing, inpatient outpatient, after meet, considered outpatient, covered Medicare, hospital care, hospital stay
