About Medicare Coverage

Medicare participants have the right to receive necessary hospital services covered by Medicare or your Medicare Health Plan (“your Plan”) if you are a Plan enrollee.

You also have the right to know about any decisions that the hospital, your doctor, Plan or anyone else makes about your hospital stay and who will pay for it.

Your doctor, Plan or the hospital should arrange for services needed after your discharge. Medicare or your Plan may cover some care in your home (home health care) and other kinds of care, if ordered by your doctor or Plan. You have a right to know about these services, who will pay for them and where you can get them.

If you have any questions, talk to your case manager, doctor or Plan.

  • Date of discharge

    When your doctor or Plan determines that you can be discharged from the hospital, you will be advised of your planned discharge date. You may appeal if you think that you are being asked to leave the hospital too soon. If you stay in the hospital after your planned discharge date, it is likely that charges for additional hospital days will not be covered by Medicare or your Plan.

    Your right to an immediate appeal without financial risk

    If you think you are being asked to leave the hospital too soon, when you are advised of your planned discharge date, you have the right to appeal to your Quality Improvement Organization (QIO). The QIO is authorized by Medicare to provide a second opinion about your readiness to leave. For more information pertaining to your QIO and a second opinion, you may call Medicare toll-free, 24 hours a day, at 1-800-MEDICARE (1-800-633-4227), or TTY/TTD: 1-877-486-2048. If you appeal to the QIO by noon the day after your receive a non-coverage notice, you are not responsible for paying for the days you stay in the hospital during the QIO review, even if the QIO disagrees with you.

    The QIO will decide within one day after it receives the necessary information.

  • If you miss the deadline for filing an immediate appeal, you may still request a QIO review (or by your Plan, if you are a Plan enrollee) before you leave the hospital. However, you will have to pay the costs of your added days in the hospital if the QIO (or your Plan) denies your appeal. You may request this review at the address or telephone number of the QIO (or of your Plan).