What is the Medicare MOON?
What’s the Medicare MOON? It’s not the same moon astronauts visited in the 60s! It’s the Medicare Outpatient Observation Notice. Join Medicare expert Toni King as she discusses Medicare’s MOON and why determining whether you’re an inpatient or an outpatient matters.
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MOON Rules
The Medicare rule is explained in the section of the Medicare & You handbook titled “Am I an Inpatient or Outpatient?” One must learn that a hospital stay doesn’t always mean you’re an inpatient. Nor does this mean that you qualify for Medicare Part A skilled nursing facility care, or that you may have to pay 100% out of your pocket.
This Medicare Outpatient Observation Notice (MOON) went into effect a few years ago and applies to those with an original Medicare hospital stay. It does not apply to those with Medicare Advantage Plans.
The MOON rule is explained in more detail in Medicare & You. The handbook states: “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.
The MOON continued…
Chapter 2 of the Toni Says® Medicare Survival Guide Advanced edition explains Medicare’s MOON notice and skilled nursing 3-day rule in easy-to-understand terms. Below is what you, your family members, or caregivers need to know when having a hospital stay:
- Remember the MOON rule applies to those on “Original Medicare” and not
Medicare Advantage Plans. Advantage Plans have their own rules regarding
inpatient/outpatient services. - Discuss the hospital procedure with your physician or surgeon regarding whether this
will be an inpatient or outpatient stay. - You or a family member should ask every day if you or your loved one is an
outpatient or an inpatient that has been “formally admitted.”
The Importance of Part D
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Originally published December 27, 2023
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