Managing your care at home after an inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). hospital or skilled nursing facility (SNF) Skilled nursing facilities (SNFs) are Medicare-approved facilities that provide short-term post-hospital extended care services. stay can be confusing and difficult. Medicare Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. covers care coordination (also called transitional care management) if you need assistance organizing your care after leaving a facility, whether you were an inpatient or an outpatient An outpatient is a patient who has not been formally admitted into the hospital as an inpatient. Most outpatient care is covered under Medicare Part B (medical insurance). . Your primary care provider (PCP) The primary care provider (PCP) is the doctor or other health care worker who manages your health care and gives you a referral to consult a specialist if you need it. In Medicare Advantage, many Health Maintenance Organizations (HMOs) require you to select a PCP and get their permission or referral before seeing a specialist. Preferred Provider Organizations (PPOs) and Private Fee-for-Service (PFFS) plans do not have this requirement. may automatically provide care coordination, or you can request services by asking that your hospital or SNF notify your PCP about your discharge Discharge is the end to your stay as an inpatient in a medical institution such as a hospital or skilled nursing facility (SNF). home.
Under this benefit, you should receive an in-person visit from your provider within 7 or 14 days of your return home, depending on the complexity of your condition. Your provider should offer the following services, as necessary:
- Contact you within two days of leaving the hospital or SNF
- Work with your other health care providers to provide education and other services to help you transition back to living at home
- Review your need for follow-up visits and help you schedule them
- Identify medical needs you have and arrange referrals to follow-up care and other community resources
Costs
Part B covers care coordination after a hospital or SNF stay at 80% of the Medicare-approved amount See Approved Amount. if you receive the service from a participating provider. You pay a 20% coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. after you meet your Part B deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. ($257 in 2025).
If you have questions about receiving this benefit, speak to your primary care provider.