Stage 3
Something just happened. Start here.
A hospital admission, a fall, a new diagnosis, a discharge you were not prepared for. Decisions made in the next 72 hours shape everything that follows. This page tells you what to ask, what to watch for, and what the hospital is not required to tell you on its own.
Dollar figures reflect 2025 Medicare rates. CMS adjusts these annually. Verify current rates at medicare.gov before making decisions.
Start here - most situations follow the same path
If someone was just admitted, begin with Hospital admission. Then check Observation status before anything else. Before leaving, review Discharge planning.
If this is a medical emergency, call 911. Project Kos is a navigational resource, not a crisis service.
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Do these first
The first 72 hours - regardless of what happened
1
Ask about admission status
Inpatient or observation. The answer affects what Medicare pays for next. Ask the moment you arrive. Ask again if anything changes.
2
Ask for the case manager
Do not wait to be introduced. Request a case manager meeting on day one. They control what happens at discharge and what gets ordered. You want to meet them early.
3
Get the discharge plan in writing
Before anyone leaves the hospital, ask for the discharge plan in writing. Where are you going, who ordered what equipment, and what follow-up is scheduled.
4
Do not rush the discharge
You have the right to appeal a discharge you believe is unsafe. Calling the QIO stops the discharge while it is reviewed. You cannot be billed for that time.
Choose what matches your situation. If you're unsure, start with hospital admission.
What happened
Start here
Hospital admission
Begin here. Who the decision-makers are, what inpatient vs. observation means for your coverage, and the questions to ask in the first 24 hours.
Inpatient status
Observation
MOON notice
Open guide
Do not miss this
Observation status
This can cost thousands if missed. You are in a hospital bed. Your care looks identical to inpatient. But observation status means Medicare may not cover the skilled nursing stay you need after discharge.
Two-midnight rule
SNF eligibility
Appeal rights
Open guide
Next step
Discharge planning
Discharge happens fast. This determines where you go next. Your rights, how to slow it down, and how to choose where you go next.
Appeal a discharge
QIO process
Home vs. SNF
Open guide
After the hospital
Rehab decisions
SNF, inpatient rehab facility, home health, or outpatient therapy. Each one is different. The choice made at discharge has real financial and clinical consequences.
SNF vs. IRF
Coverage limits
Home health
Open guide
Patient rights
Your rights as a patient
The Important Message from Medicare, the right to appeal, how to contact the QIO, and the protections that apply at every care setting.
Important Message
QIO appeal
Grievance rights
Open guide
New diagnosis
A new diagnosis
Cancer, heart failure, Parkinson's, COPD, dementia. The first week after a serious diagnosis - what Medicare covers, who to involve, and what decisions cannot wait.
Specialist referral
Care planning
Advance directives
Open guide
Next steps
What most people do next
1
Confirm admission status
Verify inpatient vs. observation immediately. This affects hospital billing, SNF eligibility, and what Medicare may cover after discharge.
2
Meet the case manager
Request this proactively. The case manager is often the person coordinating discharge, referrals, home health, and equipment.
3
Plan discharge early
Do not wait until the day before discharge. Ask where the patient is going, what has been ordered, and what is still unresolved.
4
Prepare for aftercare
Rehab, skilled nursing, home health, outpatient therapy, and equipment decisions happen quickly once discharge planning begins.
72 hrs
QIO appeal window
You must contact the QIO before or shortly after a discharge to trigger the appeal and protection from billing
3 days
Qualifying hospital stay
Three inpatient days - not observation days - are required before Medicare covers a skilled nursing facility stay
$1,676
Part A deductible (2025)
Per benefit period, not per year. Two hospitalizations that start separate benefit periods means two deductibles
$209.50/day
SNF days 21 through 100
Days 1 through 20 are fully covered. Days 21 through 100 carry this daily coinsurance. After day 100, Medicare pays nothing
Six questions to ask before leaving the hospital
"Am I admitted as inpatient or am I under observation status?"
The answer determines whether Medicare will cover a skilled nursing stay after discharge. Ask at admission, ask if anything changes, ask the day before discharge.
"Can I meet with the case manager today?"
The case manager plans your discharge and controls what gets ordered. Meeting them early - not the day before discharge - changes what options are available to you.
"What needs to happen before discharge is safe?"
Ask the attending physician directly. The answer tells you whether the discharge is clinically driven or insurance driven. These are different situations with different rights.
"Can I have the discharge plan in writing before I leave?"
A written discharge plan documents where you are going, what equipment was ordered, what follow-up is scheduled, and who is responsible for each piece.
"Can I choose my own skilled nursing facility or home health agency?"
Yes, under Original Medicare. The hospital can suggest but cannot require you to use a specific facility or agency. Get a list from the case manager and research your options.
"What happens after my Medicare skilled nursing coverage ends?"
Medicare SNF coverage ends when skilled need ends - not when daily help ends. Ask what the transition plan is before you arrive at the facility, not after coverage stops.
If you believe a discharge is unsafe, you can stop it. You have to act quickly.
Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) before or by noon the day after discharge. The QIO reviews the case and Medicare must hold the discharge while the review is pending. You cannot be billed for any days the hospital holds you during an active QIO review. Find your QIO at cms.gov or call 1-800-MEDICARE to be connected.
About the figures on this page. Dollar amounts and program thresholds reflect published 2025 rates from the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA). CMS adjusts most figures annually, typically in the fall before each coverage year. Verify current rates at medicare.gov or ssa.gov before making enrollment or coverage decisions. Project Kos is an educational resource. Nothing on this page is legal, financial, or medical advice.
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