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A recent article from CNN explains the type of hospitalizations that Medicare will pay for and what they won’t if you don’t meet their strict & sometimes controversial guidelines.

The article talks about how a elder patient was taken to the hospital after she had breaks in her pelvis after falling down. At the hospital, she stayed a total of 5 days with 4 nights.

According to Medicare policies, they cover the full cost of up to 20 days in a skilled nursing facility only if the patient stayed 3 days in the hospital as an inpatient. Even though she stayed in the hospital for 5 days, she was cared for under observation services. Because she didn’t meet the requirements, she had to pay over 7,000 dollars when she went to the skilled nursing facility after the hospital visit.

Difference between Observation & Inpatient services

These two types of services are often misunderstood which could mean the difference between paying a lot of “out of pocket” expenses or very little.

When you are taken care under observation services, you are considered an outpatient. This is when a patient is held at the hospital to perform tests and have occasionally check ups to see if you are well.

Inpatient service is when you need more intensive care.

This situation has happened to many senior citizens also.

Medicare is strict with its requirements and continuously working to cut its costs. According to the article, Medicare hires auditors which earn based on a percentage of what they recover to second guess when someone is taken into inpatient care. An auditors income is basically based on how much they say that a inpatient service was actually a observation care service which can be borderline at times. So you can see what is driving them to recover costs for Medicare. The costs for inpatient care is also much higher than observation care.

The video below (provided by CNN) also talks about the problems with Medicare and our financial crisis by driving up the cost of health care, because it talks about them taking in more money than its paying out.

The cost of care can be confusing and very expensive. Its best to know more about the industry. For more information about trusted senior resources, visit our page here: https://familybridges.com/senior-resources/

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