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How the Two-Midnight Rule Affects Your Medicare Part A Benefits

two midnight ruleHave you or a family member been to the emergency room and left wondering why you weren’t admitted? It might be because a new rule called the “Two-Midnight Rule” prevented your doctor from ordering the admission.

The “Two-Midnight Rule” requires that physicians provide sufficient evidence in your medical chart that your condition warrants a hospital stay no shorter than two nights to be considered for inpatient status. Anything less than two nights will result in your stay being considered outpatient.

How Hospital Status Affects Your Out-of-Pocket Costs

Your hospital status could have dramatic effects on your wallet. When you’re admitted to the hospital, you’re responsible for the Medicare Part A deductible ($1,216 for 2014). Other than your physician’s charges, that deductible covers all of your hospital charges for the first 60 days. If you remain an outpatient, you’re responsible for the Medicare Part B coinsurance of 20% for all of your charges including hospital charges. This could very quickly surpass $1,216.

In addition, any medications provided during an outpatient stay aren’t covered by Medicare Part B, and most medications can be quite expensive. Even if you have your own medications at home, most hospitals don’t allow you to bring them with you.

The Risk to Skilled Nursing Benefits

If you need additional care after you leave the hospital, such as care in a skilled nursing facility, your inpatient or outpatient status will determine if Medicare will cover your expenses. If you’re admitted to the hospital for a minimum of three days (not including the day you’re discharged), Medicare will cover your care at a skilled nursing facility if necessary. However, if you remain an outpatient or don’t meet the three-day minimum, skilled nursing won’t be covered.

It’s important that you ask your physician or other hospital staff what your options are if you know Medicare won’t pay for skilled nursing. You might want to consider other alternatives such as home nursing care or receiving care at an outpatient centers or office setting.

There are several lawsuits pending regarding the Two-Midnight Rule, so this heated debate isn’t over yet – but you’ll want to be sure you know your hospital status if you’re ever in this situation so you’ll know exactly what your financial responsibility will be. What is your opinion on the Two-Midnight Rule? Have you been affected by this new rule?

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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