I Need Help Now
Something just happened.
Here's what to do next.
Select the situation that matches where you are. You'll get a plain-language sequence — what to do right now, what to do today, and what to watch for — specific to exactly where you are.
What just happened?
Hospital admission after surgery
Surgery just finished — planning for what's next
ER visit — may or may not be admitted
In the ER or just discharged from it
New serious diagnosis
At a specialist or primary care — the plan just changed
Fall or injury at home
Assessed but sent home — not hospitalized
Condition is getting worse
The current plan isn't working anymore
I just got the call
Finding out from a distance — on the way there
Select a situation above to get a specific, step-by-step guide for where you are right now.
Hospital — post-surgery
Surgery is done. Here's what happens in the next 48 hours.
Discharge planning starts before most families realize it has. What happens in the first few hours after surgery — who gets called, what gets decided, which status is assigned — determines what Medicare covers for the entire next phase of care.
The clock you can't see is already running
The discharge planner is already working your case. They will call family, propose a destination, and move toward discharge on a timeline that serves the hospital's needs — not necessarily yours. You have rights that only matter if you use them quickly. Everything below tells you how.
Right now — within the first 2 hours
1
Find out the admission status — immediately
Ask any staff member: "Is she admitted as an inpatient, or is she under observation?" Write down the answer and who told you. Observation status looks identical to admission from the inside — same bed, same nurses, same care — but Medicare treats it completely differently. Three observation days do not qualify for a Medicare-covered skilled nursing facility stay. If the answer is observation, ask the social worker today what that means for what comes next.
2
Ask to speak with the social worker or discharge planner
Don't wait for them to find you. Go to the nurses' station and ask: "Can someone connect me with the discharge planner or social worker assigned to this patient?" Introduce yourself, give your contact information, and ask when they expect to begin planning discharge. They are your most important contact in this building.
3
Ask the attending doctor what they expect to happen after discharge
Not the surgeon specifically — find out who the attending physician is and ask: "Based on what you're seeing, where do you think she'll go when she leaves — home, a rehab facility, or somewhere else?" Their expectation may differ from what the discharge planner is planning. You want to know both.
Today — within 24 hours
4
Understand the discharge destination options
The three most common paths after orthopedic surgery: Skilled nursing facility (SNF) — covered by Medicare Part A for up to 100 days (days 1–20 fully covered) after a qualifying 3-night inpatient stay. Requires skilled care such as physical therapy. Inpatient rehab facility (IRF) — more intensive, requires 3 hours of therapy per day. Higher bar but faster recovery for some. Home with home health — physical therapy and nursing visits at home, covered by Medicare when patient is homebound. The right answer depends on the injury, her baseline, and her home situation.
5
If a SNF is likely — start evaluating now, not the day of discharge
The hospital may give you a list of facilities. You are not required to use any facility on their list. You have the right to choose. Ask for the list, then independently check each facility's Medicare rating at medicare.gov/care-compare. Look at staffing ratings and health inspection results specifically. A facility with a 1-star rating is not the same as a 5-star — and the difference matters enormously at this stage of recovery.
6
Know her insurance exactly
Find her Medicare card and any supplemental insurance cards. If she has Original Medicare plus a Medigap supplement, the SNF daily coinsurance (days 21–100, roughly $200/day) is likely covered by the supplement. If she has Medicare Advantage, the plan has its own SNF benefit and you will need to get an authorization from them before she transfers. These are different situations with very different financial implications.
This week — before she leaves the hospital
7
If discharge feels too soon — appeal immediately
If the hospital proposes a discharge date that feels premature, you have the right to appeal the same day. Call 1-800-MEDICARE and ask to speak with the BFCC-QIO for your region — a federally contracted organization that reviews hospital discharge decisions. You cannot be discharged while the appeal is pending. This is a real right that most families don't know exists.
8
The discharge checklist — before she leaves
Confirm each of these before leaving: Equipment ordered — walker, hospital bed, shower chair as needed. Home health ordered if going home — the order must go to a Medicare-certified agency. All prescriptions filled — don't leave without every medication she'll need. Follow-up appointment scheduled — with the surgeon and primary care. Wound care instructions in writing. Who to call if something goes wrong in the first 48 hours.
The questions that change everything
"Am I admitted as inpatient or under observation?"
Determines whether Medicare covers a skilled nursing facility stay. Ask within the first hour. Observation status is correctable — but only if caught early.
"Who is the discharge planner and when can I meet them?"
This person controls the post-discharge plan. Find them before they find you — and before a plan is finalized without your input.
"How many qualifying inpatient nights does she have so far?"
You need 3 inpatient nights to qualify for Medicare SNF coverage. Track this daily. Observation nights don't count — even if she's in a bed the whole time.
"What is the target discharge date and what does she need to meet it?"
Get this in writing. It tells you the timeline you're working with and what goals are being used to make the decision.
Watch for these warning signs
Discharge proposed before 3 inpatient nights — ask about SNF coverage before agreeing
No one mentions a discharge planner — ask for them by name on day one
Equipment not ordered before discharge — a walker arriving three days later means three days without it
SNF on the hospital's list only — you have the right to choose any Medicare-certified facility
Prescriptions not reconciled — leaving without a full medication list causes preventable ER returns
No follow-up appointment made — this is a serious gap. Don't leave without it.
Free help is available — right now
Your state has a free SHIP (State Health Insurance Assistance Program) counselor who can explain exactly what Medicare covers in this situation, review your options, and answer any coverage question at no cost. Find yours at shiphelp.org. If discharge feels premature, call 1-800-MEDICARE and ask for the BFCC-QIO in your region.
Where to go next
Emergency room
In the ER or just discharged from one.
The ER is a decision point, not a destination. What happens in the next few hours — whether you're admitted, under observation, or sent home — determines what Medicare covers for everything that follows. The questions below are the ones that change the outcome.
The ER is where observation status most often happens
Patients who come through the ER are frequently placed under observation status rather than being formally admitted — even when they're kept overnight. You feel like you're admitted. Medicare treats you as an outpatient. Ask the question within the first hour.
Right now — in the ER
1
Ask: "Are you admitting her, or is she under observation?"
Ask this directly to the attending ER doctor or the charge nurse. Write down the answer. If they say observation, ask: "Is there a possibility of converting to an inpatient admission given her condition?" This question — asked directly and early — sometimes changes the outcome.
2
Find out what they're looking for
Ask the doctor: "What would need to happen — or not happen — for her to be admitted versus sent home?" Understanding the clinical criteria being used tells you what to watch for and whether to push for a second opinion.
3
If she's being sent home — get everything in writing before leaving
Before leaving the ER: written discharge instructions, all prescriptions, follow-up appointment scheduled (not just "see your doctor"), and a clear description of what symptoms should bring her back. Ask specifically: "What should I watch for in the next 24 hours that means I should bring her back?"
If she's being admitted or staying overnight
4
Track the clock on inpatient nights
Medicare requires 3 qualifying inpatient nights for SNF coverage. Note the date and time she was formally admitted — not just when she arrived in the ER. Ask nursing staff to confirm the admission time in the chart.
5
Ask for the social worker before the next morning
Even if discharge isn't being discussed yet, find the social worker and introduce yourself. Ask what the likely discharge destination is. Getting into this conversation early gives you options. Waiting until the day before discharge does not.
If the ER visit turned into an admission: Switch to the hospital admission guide above — the post-admission steps are more detailed there. Come back here for ER-specific questions.
The questions that change everything
"Are you admitting her or placing her under observation?"
Ask within the first hour. The answer determines SNF coverage eligibility and cost-sharing rules for the entire stay.
"What would it take for this to become an inpatient admission?"
Asking the clinical criteria directly sometimes changes the physician's calculus — particularly for borderline cases.
"What should we watch for after we get home — and what brings us back?"
The most common cause of ER returns is leaving without clear criteria for when to return. Get this in writing.
Watch for these warning signs
Sent home without a follow-up appointment — schedule it before leaving
Prescriptions not filled — get them at the hospital pharmacy or confirm they're ready
Observation for more than 24 hours without written notice — hospital is required to provide the MOON notice
No one reviewed her medications — medication errors are a leading cause of ER returns
Where to go next
New serious diagnosis
A diagnosis just changed the plan. Here's what to do now.
A serious diagnosis from a specialist or primary care physician doesn't always mean a hospitalization — but it often means the care plan, the costs, and the daily reality are about to change significantly. The first 72 hours set the foundation for everything that follows.
Right now — same day
1
Write down exactly what was said — before you leave the parking lot
People retain about 20% of what a doctor says in an appointment where serious news is delivered. Before you drive away, write down the diagnosis name exactly as stated, the stage or severity, what the doctor said would happen next, what they recommended, and any follow-up appointments mentioned. If you weren't in the room, call immediately and ask someone to read their notes to you.
2
Ask for the written after-visit summary
Every appointment generates documentation. Ask for the after-visit summary or the clinic notes before leaving — or request them through the patient portal. The written record often contains details the verbal conversation missed or that you didn't absorb in the moment.
3
Don't make any coverage decisions today
A serious diagnosis is not the day to switch insurance plans, change Medicare coverage, or agree to any financial arrangements. Give yourself 48 hours before making any decisions that can't be undone. The exception: if the diagnosis affects an active care situation — hospitalization, equipment order, home health — act on those immediately.
Within 48 hours
4
Understand what Medicare covers for this condition
Many serious diagnoses — heart failure, COPD, diabetes, cancer, renal disease — have specific Medicare benefit programs attached to them. Chronic Care Management (CCM) services, Disease Management programs, and specialist referral pathways are all covered. Ask the primary care physician specifically: "What Medicare-covered programs or services are available for this diagnosis?"
5
Consider a second opinion — Medicare covers it
Medicare Part B covers a second opinion for serious diagnoses. You do not need a referral under Original Medicare. If the diagnosis is serious and the recommended treatment is significant — surgery, chemotherapy, major lifestyle changes — a second opinion is standard practice, not an insult to the first physician.
6
Update or create an advance directive
A serious diagnosis is the right moment — while the person is able to clearly state their wishes — to create or update an advance directive and designate a healthcare proxy. Ask the primary care physician for help completing a POLST (Physician Orders for Life-Sustaining Treatment) form if appropriate. This document travels with the patient and speaks for them when they can't.
This week
7
Review the medication list — completely
A new diagnosis often means new medications. A new medication on top of existing ones creates drug interaction risk. Ask the pharmacist — not just the doctor — to review the complete medication list for interactions. Pharmacists are trained for exactly this and the consultation is often free. If she takes more than 5 medications, ask about a comprehensive medication review covered under Medicare Part D.
8
Understand what changes at home
Depending on the diagnosis, daily life may need to change. Ask the physician: what activities are restricted, what dietary changes are required, what monitoring is needed at home, and what equipment — if any — is now medically necessary. If equipment is needed, get a prescription before leaving the next appointment and start the Medicare prior authorization process immediately.
The questions that change everything
"What Medicare-covered programs exist specifically for this diagnosis?"
Most physicians don't proactively discuss covered disease management programs. Asking directly surfaces benefits that otherwise go unused.
"Will this diagnosis change what equipment or home support she needs?"
Equipment and home health coverage requires a physician order. Getting this conversation started now, rather than in a crisis, is significantly easier.
"What does the next year look like — what should we be planning for?"
Physicians often focus on the immediate next step. Asking about the broader trajectory surfaces planning needs before they become crises.
Where to go next
Fall or injury at home
They fell. They're home now. Here's what to address.
A fall that didn't result in hospitalization still demands action. Falls are the leading cause of injury in adults over 65 — and a first fall is the strongest predictor of a second. The next 72 hours are when you prevent the next one.
Falls that look minor sometimes aren't
Subdural hematomas — bleeding around the brain — can develop hours after a head impact that seemed mild. If there was any head contact, watch carefully for confusion, headache, slurred speech, or unusual sleepiness in the next 24–48 hours. These warrant an immediate ER visit.
Right now — today
1
Watch for delayed symptoms — especially if there was a head impact
For the next 24 hours: confusion or disorientation, new or worsening headache, vomiting, slurred speech, weakness on one side, unusual drowsiness. Any of these after a fall with head impact — even a minor one — requires an immediate return to the ER.
2
Call the primary care physician today
Even if the ER cleared her, the primary care physician needs to know. A fall is a clinical event that warrants documentation, medication review, and a fall risk assessment. Call today — don't wait for the next scheduled appointment.
3
Walk through the home — today, not next week
The fall happened somewhere. Look at that spot with fresh eyes: loose rugs — remove or secure them. Inadequate lighting — particularly in hallways at night. Bathroom risks — no grab bars, slippery tub. Stairs without rails. Clutter on the floor. The most common fall hazards are the most obvious ones — they just haven't been seen that way before.
This week
4
Ask about a home safety assessment — Medicare covers it
If a home health agency is involved or can be ordered, a home safety evaluation by an occupational therapist is covered by Medicare. They will walk through the home professionally and identify fall risks, recommend modifications, and order grab bars or other equipment that Medicare will cover.
5
Review the medication list for fall-risk medications
Several medication classes significantly increase fall risk: sleep aids, benzodiazepines (Xanax, Ativan, Valium), blood pressure medications causing dizziness, muscle relaxants, antihistamines with sedating effects. Ask the pharmacist to review the full list specifically for fall risk. This conversation can prevent the next fall.
6
Consider a medical alert device
If she lives alone or is alone for significant periods, a medical alert device is worth serious consideration now — not after the next fall. Medicare does not cover these devices, but they are available at most pharmacies for $25–$40/month. The cost of one serious undetected fall far exceeds years of monitoring fees.
The questions that change everything
"Which of her medications increase fall risk?"
Ask the pharmacist specifically. Many fall-risk medications can be adjusted or substituted. This question directly prevents future falls.
"Does she qualify for home health services — and can we get a home safety eval?"
An occupational therapy home safety assessment is among the most effective fall prevention interventions available and is often Medicare-covered.
Where to go next
Condition getting worse
The current plan stopped working. Time to change it.
A gradual decline is harder to respond to than an acute event — there's no single moment of crisis to force action. But reaching a turning point where the current arrangement isn't meeting the need is exactly when the system has new tools available. Here's how to access them.
First — be specific about what's changed
1
Write down what specifically has changed — with dates
Before any appointment: document exactly what has changed and when. "She used to walk to the mailbox; she hasn't in three weeks." "She fell twice in November." "She forgot to take her medications four times this month." Specific, functional, dated observations are what physicians and insurance companies respond to. Vague statements like "she's getting worse" accomplish less.
2
Request an urgent appointment — and bring the documentation
Don't wait for the next scheduled visit. Call the primary care physician and describe the specific changes. Ask for an appointment within the next week. Bring your written list. Physicians respond to specific functional decline — it triggers clinical documentation that unlocks equipment, home health, and care plan changes.
At the appointment
3
Ask directly: "Is she a candidate for home health now?"
Medicare home health requires a physician order and that the patient be "homebound" — meaning leaving home requires considerable effort. If the condition has worsened to that point, the physician needs to order home health explicitly. Physical therapy, occupational therapy, and nursing visits at home are all covered when medically necessary. Ask if each is appropriate.
4
Ask about new equipment needs
A condition that has progressed may now meet criteria for equipment it didn't qualify for before. Power wheelchairs, hospital beds, and oxygen equipment all have specific criteria — and a physician who documents the current functional status accurately may be able to support a claim that wasn't supportable six months ago. Ask: "Given where she is now, is there equipment that would help that might be covered?"
5
Ask about the care plan going forward
Ask the physician directly: "Given the trajectory you're seeing, what do you think the next 6–12 months looks like? What should we be planning for?" This question surfaces planning conversations that physicians rarely initiate — about potential hospitalizations, medication changes, long-term care needs, and hospice eligibility if relevant.
Chronic Care Management — a covered service most people don't know exists
If she has two or more chronic conditions, Medicare covers Chronic Care Management (CCM) services — monthly coordination between her providers, medication management, and care planning. Few primary care practices proactively offer this. Ask specifically: "Does she qualify for Chronic Care Management billing?" The answer is often yes and the benefit is significant.
Where to go next
I just got the call
You found out from a distance. Here's what to do before you arrive.
You're on the phone, in the car, or on a plane. You know something happened but not all the details. The next few hours — before you arrive — are not wasted time. There are things you can find out right now that will change what you're able to do when you get there.
The information that matters most right now
Before you arrive, find out three things: (1) Is she admitted as an inpatient or under observation? (2) Has anyone spoken to the discharge planner yet? (3) What is the current plan for after she leaves? Everything else can wait until you get there. These three questions shape what you walk into.
On the way there — what to find out now
1
Call whoever is with her — ask the three questions
If a family member, neighbor, or anyone is at the hospital, call them and ask: "Is she admitted or under observation?" — "Has anyone mentioned a discharge planner?" — "What are they saying about where she goes when she leaves?" If they don't know, ask them to find a nurse and ask directly. Write down everything they tell you.
2
Find her insurance information
Try to locate her Medicare number and any supplemental insurance card before you arrive. Check: her wallet, a home folder, a safe, or a prior Medicare Summary Notice. If she has Medicare Advantage, find the plan name — prior authorization rules vary significantly by plan and you'll need this immediately for any post-discharge decisions.
3
Look up the hospital's discharge planning department
Search the hospital name + "discharge planning" or "social work department." Save the phone number. When you arrive, you can call ahead and ask to speak with the social worker assigned to her case before you even get to her room. This is faster than navigating the floor in person.
4
Know your rights before you walk in
You have the right to know her admission status. You have the right to choose her discharge destination. You have the right to request a meeting with the discharge planner. You have the right to appeal a discharge you believe is premature. Knowing these going in changes how you engage from the first conversation.
When you arrive
5
Go to the nurses' station first — not her room
Introduce yourself and ask to speak with the charge nurse assigned to her. Ask the admission status question immediately. Ask who the attending physician is. Ask who the social worker is and how to reach them. Get these names before anything else. Then go see her.
6
Find the discharge planner before they find you
Ask to be connected with the social worker or discharge planner that same day — even if discharge is days away. Introduce yourself, give your contact information, and ask: "Can you walk me through what the current thinking is for after she leaves, and what decisions need to be made and when?" This conversation, had early, gives you options. Had the day before discharge, it does not.
Now that you're in the building: Switch to the Hospital admission guide for the full step-by-step — it covers everything from this point forward in detail.
The three questions that change everything
"Is she admitted as inpatient or under observation?"
The single most financially consequential question in a hospital stay. Ask within the first hour of arrival.
"Who is the discharge planner and when can I meet them?"
This person is already working the case. Find them before a plan is made without you.
"What is the plan for after she leaves, and when does that decision get made?"
Discharge planning has a timeline. Knowing it tells you how much time you have to be involved.
Resources to have ready
1-800-MEDICARE — to request a BFCC-QIO review if you believe discharge is premature. Call the same day.
SHIP counselors — free Medicare counseling. Find your state's counselor at shiphelp.org. They can answer coverage questions in real time.
medicare.gov/care-compare — to look up quality ratings for any SNF, home health agency, or hospital you're considering.
The hospital patient advocate — every hospital has one. Ask the nurses' station how to reach them if you are not getting answers.
Where to go next
You don't have to figure this out alone.
Free, unbiased Medicare counseling is available in every state. SHIP counselors answer coverage questions at no cost — no insurance sold, no agenda.