Why did I have to sign a Medicare form in the ER?

by
Toni
King

Hello
Toni:

I
have
Original
Medicare
with
a
Supplement.
In
March,
I
was
ambulanced
to
the
emergency
room
for
heart
issues.
I
had
a
big
surprise
when
a
hospital
employee
asked
me
to
sign
a
Medicare
form
while
I
was
waiting
in
the
ER
to
see
if
I
was
to
be
admitted
as
an
inpatient
or
sent
home.
I
was
lucky
that
the
doctor
sent
me
home.

Did
I
do
the
right
thing
to
sign
the
Medicare
form
while
waiting?
My
sister
said
that
I
should
contact
you
because
she
did
not
have
to
do
this
when
she
had
cataract
surgery
last
summer.
Looking
forward
to
what
you
have
to
say
about
being
admitted
into
the
hospital
from
the
ER.
Thank
you,
Toni.

—
Sandra
from
Sugar
Land,
Texas

Hi
Sandra:

Your
hospital
situation
was
different
from
your
sister’s
because
she
was
having
out-patient
surgery,
and
you
were
in
the
emergency
room
due
to
a
health
issue.
“Original”
Medicare
—
not
Medicare
Advantage
(MA)
plans
—
has
two
different
situations
when
one
is
asked
to
sign
a
Medicare
form.

The
first
circumstance
is
Medicare’s
Outpatient
Observation
Notice
rule.
It
only
affects
those
who
are
enrolled
in
“Original
Medicare”
with
or
without
a
Medicare
Supplement.
The
second
is
Medicare’s
“Lifetime
Reserve
Days,”
which
gives
someone
on
Medicare
365
days
in
a
hospital
stay
“extra”
only
when
one
has
a
Medicare
Supplement,
such
as
what
you
are
enrolled
in,
Sandra.
Remember
that
the
two
Medicare
rules
ONLY
affect
those
enrolled
in
original
Medicare,
not
an
MA
plan.

1.
Medicare
Outpatient
Observation
Notice
(MOON)
is
available
for
those
enrolled
in
original
Medicare
with
or
without
a
Medicare
Supplement.
This
Medicare
rule
began
a
few
years
ago.
Page
28
of
the
2025
Medicare
&
You
handbook
completely
explains
this
rule
under
“Am
I
an
inpatient
or
outpatient?”
It
states,
“Each
day
you
have
to
stay,
you
or
your
caregiver
should
ask
the
hospital
and/or
your
doctor,
a
hospital
social
worker,
or
a
patient
advocate
if
you’re
an
inpatient
or
outpatient.”
Know
whether
you
are
an
“inpatient
or
outpatient,”
because
it
affects
what
is
covered
in
the
hospital.

2.
Lifetime
Reserve
Days
are
explained
on
page
27
of
the
handbook.
For
2025,
Medicare
Part
A
covers
an
inpatient
hospital
stay
with
a
$1,676
deductible
for
days
1-
60,
6
times
a
year.
For
days
61
through
90,
Medicare
pays
all
but
$419;
days
91
and
thereafter,
Medicare
pays
all
but
$838
with
the
60
“Lifetime
Reserve
Days”
to
be
used.
Once
the
lifetime
reserve
days
are
used,
then
the
“inpatient
hospital
benefits”
are
exhausted
and
you
will
pay
all
the
cost.

Sandra,
you
have
a
Medicare
Supplement
Plan
G,
and
your
Part
A-Inpatient
Hospital
costs
are
paid
for
by
the
plan
with
an
“extra”
365
days
of
inpatient
hospital
coverage
that
only
a
Medicare
Supplement
will
pay
for.
During
the
“extra”
365
days,
the
hospital
is
forbidden
to
bill
you
for
the
balance.
It
must
bill
the
Medicare
Supplement,
and
the
hospital
must
sign-off
on
specific
Medicare/hospital
forms.

There
is
a
notice
written
in
the
summary
of
benefits
of
Medicare
Supplement
policies
that
states,
“NOTICE:
When
your
Medicare
Part
A
hospital
benefits
are
exhausted,
the
insurer
stands
in
the
place
of
Medicare
and
will
pay
whatever
amount
Medicare
would
have
paid
up
to
an
additional
365
days
as
provided
in
the
policy’s
‘Core
Benefits.’
During
this
time,
the
hospital
is
prohibited
from
billing
you
for
the
balance
based
on
any
difference
between
its
billed
charges
and
the
amount
Medicare
would
have
paid.”

This
is
good
news
for
you,
Sandra.
Because
you
have
a
Medicare
Supplement,
you
will
have
an
additional
365
days
of
“inpatient
hospital
benefits”
that
only
a
Medicare
Supplement
insurance
plan
will
pay.
If
you
do
end
up
in
the
hospital
for
a
long
time,
you
will
luckily
pay
$0
for
the
“additional
365
days.”