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Seniors should be aware of Medicare’s 3-day hospital rule. There are significant implications for beneficiaries of Medicare, particularly those who may need skilled-nursing facility care after a hospitalization.

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Inpatient Status is Critical

To be eligible for Medicare coverage of care in a skilled-nursing facility (SNF) the patient must spend three consecutive days as an inpatient in a hospital. (Technically the rule could be called a “three-night” rule since the patient must occupy an inpatient bed for 3 consecutive midnights.) Observation status or time in an emergency room do not count toward the 3-midnight requirement. Many client families are unaware of this rule. It can significantly impact out-of-pocket expenses and admission to an SNF for rehabilitation services. Navigating these regulations demands diligence and knowledge.

Why is this rule necessary? Medicare Part A addresses hospital stays, while Part B pertains to outpatient services. However, for those eyeing SNF care, activation of Part A is imperative and contingent upon adherence to the 3-midnight stipulation.

Are There any Exceptions?

During the Covid Public Health Emergency (PHE), CMS waived the 3-day stipulation. The PHE has ended, but certain Accountable Care Organizations (ACOs) and Medicare Advantage plans still have authority to forego a 3-day inpatient hospital stay. Therefore, it is crucial to understand your plan’s benefits if you are covered under an ACO or a Medicare Advantage plan.

Medicare.gov further explains how the three days are counted. Read carefully to ensure you are aware before your loved one has a hospital visit. We always counsel our families to be proactive with their health plans and decisions. Educating yourself in advance can make a critical time less stressful. Call our experienced intake coordinators at 239-434-8557 with any Florida elder law questions. We are always ready to assist you.