There may come a time over the course of your health care journey when you will need to stay overnight in a hospital. This can happen for a wide variety of reasons. However, you and your family will need to consider how or whether this impacts your skilled nursing care coverage under Medicare.
You or your family may receive a Medicare Outpatient Observation Notice (MOON), but if you have never received it, it can be hard to know what steps to take next. Read below about what this is and what questions you might have about the impact of this on your general care needs.
What is Medicare Outpatient Observation Notice (MOON)?
A Medicare Outpatient Observation Notice (MOON) is a document that provides you notice as to whether or not you are considered an inpatient during your hospital stay. This can be confusing to some because if the hospital does not designate you an inpatient, but you still have an overnight stay, you may be considered an outpatient. You must be formally admitted as an inpatient before receiving a MOON.
You must receive this notice if you’re getting observation services as an outpatient for more than 24 hours.
The MOON will inform you and your family as to how this impacts your health care costs so you have some notice as to anything that may be out of pocket. This can vary from patient to patient as well as the situation you may be in when you go to the hospital for care. This can also impact whether you’ll qualify for Medicare Part A coverage in a skilled nursing facility.
Questions to Ask About MOON
Am I an inpatient or outpatient?
You should find out from the hospital staff if you’ve been formally admitted as an inpatient. Regardless if you…
- stay overnight in a regular hospital bed
- are receiving emergency department services
- are receiving observation services, outpatient surgery, lab tests, or X-rays
you may be still considered an outpatient.
How will my stay affect my care after leaving the hospital?
Medicare covers the following:
- Semi-private rooms
- Skilled nursing and rehabilitative services
- Other medically necessary services and supplies furnished in a skilled nursing facility
However, Medicare only covers the above after a 3-day minimum, medically necessary, inpatient hospital stay for a related illness or injury. According to the Medicare handbook, “to qualify for skilled nursing facility care coverage, your doctor must certify that you need daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.”
Contact Steinlage Insurance Agency
If you are on Medicare, be sure to find out as soon as you can if you are considered inpatient or outpatient. And, if you have other questions about Medicare and how the MOON affects your coverage, contact the Medicare insurance brokers at Steinlage Insurance Agency for additional help.