Controlling the Cost of Medicare

Turn on the national evening news any day of the week and you are guaranteed to see at least one story about the Medicare system.  With people living longer and the price of health care increasing, insurers are looking at new and creative ways to control costs.

As the Admissions Supervisor at The Friendly Home, I have seen an increase in the use of “Observation” status at our local hospitals.  Observation can be used to extend the period of time for assessment.  Sometimes doctors just aren’t sure if you are sick enough to be admitted to the hospital or safe enough to be discharged home.  You might not even know that you are classified as observation because more often than not, you will be moved out of the Emergency Department to a hospital room while they await the results of your tests. This doesn’t necessarily mean you have been admitted.

With traditional Medicare Part A, an inpatient hospital stay is covered in full minus your fixed deductible.  Observation status, however, is covered under Medicare Part B, which pays for outpatient services and includes a 20% co-payment.  The 20% co-payment most likely will cost more than the Medicare Part A fixed deductible.  Adding insult to injury, should you require post-hospital care at a nursing home, Medicare will not pay for any part of your stay unless you have had a three-day inpatient admission and meet the qualifications for skilled services.  Basically, this means you will be paying out-of-pocket for your entire nursing home stay.  It quickly adds up considering an average rehab stay costs $400/day!

How do you advocate for yourself?  1) Don’t assume your stay is covered just because you are in a hospital bed.  2) Ask the care manager or utilization review nurse about your status – whether you are considered observation or admitted. 3) If your status is observation, the best thing to do is to appeal while you are still in the hospital.  It is easier to make your case in person than to wait until you are a file in the Medical Records department.  5) Be aware – the hospital cannot change your status once you’ve been discharged.

My advice to you:  make sure you give a full disclosure of your medical history.  Ask to have your labs double-checked.  If necessary, have your primary care physician contact the hospitalist caring for you. Little details can make the difference in determining your status.  Let the medical team know of any changes in your baseline level of functioning.  Remember, the squeaky wheel gets the grease.  Health care is a physical, mental and financial investment.  And, no one is as invested in your healthcare as you!

The August 2012 issue of Money magazine has a great article called “This Could Hurt – A Lot.”  The article covers the rationale for use of observation status as well as helpful suggestions should you find yourself in that position in the hospital. Read it here:

Should you have any questions, please do not hesitate to contact me.  I can be reached at 585-385-0271 or

Back to Blog Posts