Toni Says Newsletter Alert:  Around October 1, the 2018 Medicare & You handbook should have arrived in everyone’s mailbox with a surprise on page 32 titled, “Am I an inpatient or outpatient?” if you are currently on Medicare.


What does that mean?  Let’s discuss it…

          A new Medicare rule called Medicare Outpatient Observation Notice (MOON) went into effect on Wednesday, March 8th, and applies to those with an Original Medicare hospital stay. It does not apply to those with Medicare Advantage plans.

This new rule is explained differently and with more details than when first released last March, and in the 2018 Medicare and You handbook, it states in the entire passage….

“Staying overnight in a hospital doesn’t always mean you’re an inpatient. You only become an inpatient when a hospital formally admits you as an inpatient, after a doctor orders it. You’re still an outpatient if you haven’t been formally admitted as an inpatient, even if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays. You or a family member should always ask if you’re an inpatient or an outpatient each day during your stay, since it affects what you pay and can affect whether you’ll qualify for Part A coverage in a skilled nursing facility.”

Last March when the Toni Says® office became aware of the new MOON (Medicare Outpatient Observation Notice), the law read that “beginning March 8th, hospitals and critical access hospitals must provide the MOON (Medicare Outpatient Observation Notice) to Medicare beneficiaries or their legal representative if receiving observation services as an outpatient for more than 24 hours.  The MOON must be provided in written form that is signed and dated with an oral explanation from the facility no later than 36 hours from the time the Medicare patient begins receiving outpatient observation services. This time limit is considered the new two midnight stay observation policy.”

It seems that on page 32 of the Medicare & You handbook that one who is having a hospital stay should be more involved or one may have to pay more if they happen to need a skilled nursing stay.

When I read page 32, I knew that many on Medicare would not see this information and may have to pay thousands of dollars for additional hospital or skilled nursing care.

Below is what you should know when having a hospital stay and what you may want to inform your family members or caregivers:

  1. Remember the MOON rule applies to those on “Original Medicare” and not Medicare Advantage plans, as Medicare Advantage Plans have their own rules and options regarding inpatient/outpatient services.
  2. Discuss your hospital procedure with your physician/surgeon regarding whether this will be an inpatient or outpatient stay.
  3. Remember you only become an inpatient once the hospital, not your doctor, “formally admits” you with a doctor’s order.
  4. You or a family member should ask every day if you or your loved one is an inpatient or an outpatient. (This information was highlighted on page 32 meaning it is important!)
  5. Read on page 32 regarding the Medicare Outpatient Observation Notice (MOON), which advises you if you are in an outpatient rather than inpatient status while in the hospital.
  6. Know that outpatient status does not cover any skilled nursing costs.

Contact the Toni Says® Medicare Call Center at 844/250-8664 or email Toni at regarding this information. Confused about Medicare and TRS Medicare webinars are now available online at for those who cannot attend a local workshop.

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