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News from SHINE – March 2017

Hospital Observation Stays and Original Medicare:
Many times when a person goes to the emergency room and is then placed in a hospital bed, they are not admitted as “inpatient” but are there under “observation”. When a Medicare Beneficiary is in the hospital under observation, Medicare Part B (medical insurance) will be billed not Medicare Part A (hospital insurance). This can result in increased costs for the beneficiary.  For instance, Medicare requires a three-day inpatient stay at a hospital before it will pay for any stay in a skilled nursing facility and time spent under observation in a hospital will not count towards that three-day minimum. If a Medicare Beneficiary goes to a skilled nursing facility after a stay at the hospital under observation they will be responsible for the entire bill which could be thousands of dollars. The Medicare Beneficiary may also be responsible for the Part B deductible and co-insurance if they do not have a supplement.ADVERTISEMENT

As of March 8, 2017, hospitals are required to provide a Medicare Outpatient Observation Notice (MOON) to a Medicare Beneficiary who has been receiving observation services as an outpatient for more than 24 hours. This notice will inform the individual as to the reason(s) they are an outpatient receiving observation services and the implications of such status with regards to Medicare cost sharing and post-hospital skilled nursing facility services. An oral explanation of this notice must also be provided. A signature must be obtained from the individual or a person acting on the individual’s behalf to acknowledge receipt. If the individual refuses to sign the MOON, the staff member of the hospital providing the notice must sign certifying that notification was presented.

This notice was a result of the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) which was enacted August 6, 2015. This Act will hopefully make the Medicare Beneficiary more aware of the implications of not being admitted as an inpatient.

Please call your local Senior Center to schedule an appointment with a SHINE counselor if you would like more information on this or any other Medicare issue. Trained SHINE volunteers offer free, confidential counseling on all aspects of health insurance to anyone on Medicare.

For a complete list of local SHINE locations, view SHINE brochure.

SHINE Program LogoThe Barnstable County Department of Human Services administers the regional office for the Cape and Islands SHINE Program (Serving the Health Insurance Needs of Everyone). SHINE counselors provide free health insurance information, counseling, and assistance to Massachusetts residents with Medicare and their caregivers.