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Medicare Beneficiary Alert: Are You a Hospital Inpatient?

Medicare Advocacy Project

If you are a Medicare beneficiary, Medicare can pay for up to 100 days of care in a Skilled Nursing Facility (SNF) such as a nursing home.  Unless you are in a Medicare Advantage plan which allows otherwise, to qualify for Medicare coverage, among other criteria, you must have a qualifying hospital stay of 3 consecutive days or more and need doctor-ordered skilled care or therapy on a daily basis.  However, a three-day hospital stay is not a guaranty that Medicare will pay for SNF care.  The stay must be considered an inpatient hospitalization.

This handout provides an overview of the inpatient/observation status issue and provides tips on what beneficiaries should do to protect their right to appropriate Medicare coverage.

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