Leaving the hospital: Medicare rights and next steps

1. Find out the hospital status

Your parent is an inpatient only from the moment a doctor writes an order to admit them. Without that order they are an outpatient, even after a night or more in a hospital bed. Time spent "under observation" is outpatient care.

Why it matters:

• Inpatient stays are paid by Part A. After the Part A deductible of $1,736, days 1 to 60 cost $0.
• Outpatient (observation) care is paid by Part B: usually 20% of the cost of each service after the Part B deductible of $283, plus a copayment to the hospital for each service.
• Only inpatient days count toward the 3 days needed for Medicare to pay for a skilled nursing facility afterwards (see below).

If your parent is kept under observation for more than 24 hours, the hospital must give a Medicare Outpatient Observation Notice (MOON) explaining why, and how it affects costs.

New since February 14, 2025: if your parent was admitted as an inpatient and then changed to "outpatient getting observation services", they have the right to a fast appeal of that change. The hospital should give a Medicare Change of Status Notice before they leave. If you do not get it, ask for it. It is best to appeal while still in the hospital, but you can also appeal after leaving.

2. If the discharge feels too soon: a fast appeal

Within 2 days of being admitted, and again before discharge, the hospital should give your parent a notice called "An Important Message from Medicare about Your Rights". If you did not get it, ask for it. It explains how to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), an independent reviewer.

• Deadline: follow the directions on the notice no later than the day your parent is scheduled to be discharged.
• Staying while you wait: if you ask in time, your parent can stay in the hospital while the reviewer decides, and does not pay for those days (apart from normal deductibles or coinsurance).
• Decision: usually within one day of the reviewer getting the records.
• If you lose: your parent does not pay hospital charges until noon of the day after the decision.
• If you miss the deadline: you can still ask for a review, but your parent may have to pay for days past the planned discharge.

To find your state's reviewer, use the phone number on the notice, or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, any time of day.

Medicare Advantage plans: you can still ask for a fast appeal; the reviewer tells the plan and the hospital. For other disputes, the plan has its own appeal process. You usually have 65 days from the plan's denial letter to appeal. The plan must tell you in writing how to appeal.

3. Care after the hospital

Skilled nursing facility (short-term rehab)

Medicare Part A pays for a stay in a skilled nursing facility only if:

• your parent had a medically necessary inpatient stay of at least 3 days in a row (the day of discharge does not count, and observation or emergency room time before admission does not count), and
• they go to the facility within a short time, generally 30 days, of leaving the hospital.

Costs with Original Medicare:

Medicare does not pay for long-term or custodial care in a nursing home (help with bathing, dressing and eating when that is the only care needed). See Paying for a nursing home. Some Medicare Advantage plans do not require the 3-day stay.

Home health care

Medicare pays the full cost of covered home health care (part-time nursing, physical therapy and similar skilled care at home) if:

• your parent needs part-time or intermittent skilled care, and
• they are homebound: leaving home is not advised or takes great effort, and
• a doctor or nurse practitioner sees them in person and orders the care, from a Medicare-certified home health agency.

Medicare does not pay for 24-hour care at home, meal delivery, or personal care when that is the only help needed. Medical equipment such as a walker costs 20% of the Medicare-approved amount after the Part B deductible.

4. Discharge checklist

Before your parent leaves, ask the staff:

• Where will they get care next, and what are the choices (for example, home health care)? Tell the staff what you prefer.
• Which medicines to keep taking, at what dose, and which to stop. Go through the list together.
• What problems to watch for and what to do about them.
• Whether they will need equipment such as a walker, whether Medicare covers it, and who arranges delivery.
• Who to call with questions, with names and phone numbers.
• For written discharge instructions you can read and understand, and a summary of their current health.
• To talk to a social worker about what insurance will pay and any help with costs.

Medicare's full checklist: Your discharge planning checklist (PDF).

Free help

• Your state's free Medicare counseling program can explain bills and appeals. See Free Medicare counseling in your state.
• If your parent has limited income, they may qualify for help with Medicare costs: see Extra Help and the benefits check.

Related guides

• Paying for a nursing home: Medicare, Medicaid and protecting a spouse
• Managing a parent's benefits: representative payee and power of attorney
• Medicare Part A (hospital insurance)

Check what you may qualify for