The Medicare Outpatient Observation Notice (MOON) is a form that tells you you're an outpatient getting observation services in the hospital. Medicare.gov says the hospital must give it to you if you're under observation for more than 24 hours, and CMS says it must arrive no later than 36 hours after observation starts. It matters because outpatient status changes what you pay in the hospital and whether Medicare covers nursing home care afterward.
What is the MOON?
It's a standard CMS form, CMS-10611. Medicare.gov says the MOON tells you why you're getting observation services as an outpatient, and how that affects what you pay in the hospital and for care after you leave.
The hospital fills in your name, a patient number, and the reason you're an outpatient. CMS lists the MOON under its notices for both Original Medicare and Medicare Advantage.
For a full side-by-side of observation and inpatient costs, see observation status vs. inpatient. This page focuses on the notice itself and what to do with it.
When should I get it?
According to CMS:
- The hospital must give the MOON to people getting observation services as outpatients for more than 24 hours.
- It must be given no later than 36 hours after observation starts, or sooner if you're released.
- Hospitals may give it earlier, before 24 hours have passed.
You can be in a regular hospital room, stay overnight, and still be an outpatient. If you've been in the hospital a day or more and aren't sure of your status, ask.
What to say to the nurse or case manager:
"Can you tell me if [patient name] is an inpatient or an outpatient under observation? If it's observation, may we have the Medicare Outpatient Observation Notice?"
Do I have to sign it?
CMS says the hospital must explain the notice out loud and get your signature, or your representative's, to show you got it. CMS's instructions say the hospital must answer your questions as best it can. If you refuse to sign, the hospital can note that on the form.
Signing shows you got the notice. Ask your questions first.
Questions to ask before you sign:
- "Why is this an observation stay and not an inpatient admission?"
- "Is the doctor thinking about admitting [patient name]? When will that be decided?"
- "What will we likely pay for this stay?"
- "If [patient name] needs a nursing home or rehab after this, will Medicare cover it?"
How does observation status affect my bill?
Medicare.gov explains that observation services are outpatient services, covered under Part B. In general, that means:
- Part B costs, like the Part B deductible and 20% coinsurance for doctor services and many hospital outpatient services. The Part A hospital deductible doesn't apply.
- Separate charges for each service, which can add up over a longer stay.
- Possible charges for prescription and over-the-counter drugs you'd normally take yourself, which Part B generally doesn't cover in the outpatient setting. Drugs during observation explains this and how to ask your drug plan to pay you back.
If you have Medicare Advantage, your plan's copays for outpatient care apply instead. Check your plan's Explanation of Benefits.
How does it affect nursing home coverage?
This part is easy to miss. Medicare.gov says that to cover skilled nursing facility care, Original Medicare generally requires a medically necessary inpatient hospital stay of at least 3 days in a row. Time under observation, or in the emergency room before you're admitted, doesn't count toward those 3 days, even if you stay overnight.
So a parent could spend several nights in the hospital, then need rehab, and find out Medicare won't pay for the nursing home. If rehab may be needed, ask early. See skilled nursing facility bills and Medicare.
Medicare Advantage Plans may have different rules, so ask your plan.