About Medicare coverage

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

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

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

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

  • Your hospital discharge and Medicare appeal rights

    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 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 at 1-877-486-2048. If you appeal to the QIO by noon the day after you 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.

  • Other appeal rights
    If you miss the deadline for filing an immediate appeal, you may still request a review by the QIO (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).