Grand Junction · My plan is going away
What If I'm in the Hospital When My Medicare Plan Ends?
The plan you had when you were admitted pays the whole stay, through discharge — even after its contract ends December 31. That is federal regulation, not a courtesy. Here is what the rule covers, the three things it does not, and how to read it from a Mesa County hospital bed.
The bottom line
- The rule is 42 CFR § 422.318. When Medicare Advantage coverage ends while you are an inpatient, the plan "is responsible for the inpatient services until the date of the beneficiary's discharge."
- Nobody else pays that stay. Payment for the remainder "is not made by original Medicare or by any succeeding MA organization." One admission, one payer, no second deductible.
- It works in both directions. Move from Original Medicare into a plan on January 1 mid-stay and Original Medicare pays through discharge; the new plan starts "the date after the beneficiary's discharge."
- Inpatient means admitted. Medicare.gov: "You're an inpatient starting when you're formally admitted to the hospital with a doctor's order." Observation nights are outpatient and the rule does not reach them.
- It stops at the hospital door. Skilled nursing, home health, follow-up visits and prescriptions after discharge belong to your January 1 coverage — which is why the network and formulary checks still matter.
- The calendar: pick during October 15 – December 7 for a January 1 start, or use the non-renewal Special Enrollment Period, December 8 through the last day in February. A hospital stay is not a reason to delay the choice.
Of all the questions a non-renewal letter raises, this one arrives at the worst hour. It is late December, someone you love has been admitted to St. Mary's, and a family member remembers that the plan on the insurance card ends on the 31st. Who pays the days in January? Does the new plan have to accept a patient it never approved? Does Original Medicare charge its own deductible for a stay that started under a plan? We have written this month about the first steps, the doctors, the prescriptions and an in-progress course of treatment. This is the narrower question — a hospital bed on New Year's Eve — and it has the cleanest answer of the set, because Medicare wrote it down.
What the rule actually says
The regulation is 42 CFR § 422.318, titled "Special rules for coverage that begins or ends during an inpatient hospital stay." Paragraph (c) is the one for a discontinued plan. If coverage under a Medicare Advantage plan "ends while the beneficiary is an inpatient," then three things follow, in the regulation's own words:
- "The MA organization is responsible for the inpatient services until the date of the beneficiary's discharge;"
- "Payment for those services during the remainder of the stay is not made by original Medicare or by any succeeding MA organization offering a newly-elected MA plan; and"
- "The MA organization that no longer provides coverage receives no payment for the beneficiary for the period after coverage ends."
Read the second one twice, because it answers the question families actually worry about. The plan you picked for 2027 does not pay the January days of a December admission, and neither does Original Medicare — which also means Original Medicare's $1,736 Part A deductible is not what you owe for that stay. The stay belongs to the plan that admitted you, at that plan's cost sharing, until the day you go home. The third clause is Medicare's side of the bargain: the old plan keeps the obligation without getting paid for the extra days, which is exactly why the rule needed to be written.
Who pays, in each direction
Paragraph (b) is the mirror image, for coverage that begins mid-stay, and it matters here because a discontinued plan sends people both ways — some into another plan, some back to Original Medicare with a Medigap policy. Together the two paragraphs cover every combination a January 1 change can produce.
| Coverage when admitted | Coverage on January 1 | Who pays the stay |
|---|---|---|
| Medicare Advantage plan that is ending | A different Medicare Advantage plan | The old plan, "until the date of the beneficiary's discharge." The new plan "is not responsible for the inpatient services until the date after the beneficiary's discharge." |
| Medicare Advantage plan that is ending | Original Medicare (with or without Medigap) | The old plan, until discharge. Payment for the rest of the stay "is not made by original Medicare" — so the Part A deductible is not what you owe for that stay. |
| Original Medicare | A Medicare Advantage plan | Original Medicare, until discharge. The new plan's responsibility starts the day after you leave. |
| Any of the above | Any of the above — but you were under observation, not admitted | The rule does not apply. Observation is outpatient care, and each day's charges belong to whichever coverage you hold that day. |
Source: 42 CFR § 422.318, paragraphs (b) and (c), read on the Cornell Legal Information Institute mirror of the eCFR. Observation status per Medicare.gov.
The row that surprises people is the second one. Someone whose plan is discontinued, who uses the guaranteed-issue window to buy a Medigap policy effective January 1, and who is admitted on December 28, does not start their Original Medicare life with a hospital deductible. The plan that admitted them carries the stay to discharge. Original Medicare and the Medigap policy pick up on the day after — the follow-up visits, the therapy, and, if it comes to that, the next admission, which would be a new benefit period under Original Medicare's rules. Medicare.gov notes there is "no limit to the number of benefit periods you can have in a year," so a second, separate admission later in January would carry its own $1,736 deductible, which is what the Medigap policy is for.
"Inpatient" is a status, not a bed
The regulation applies to "inpatient services," and the whole protection turns on that word. Medicare.gov's page on hospital status defines it in one sentence: "You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day." The other side is just as plain: if you are getting emergency department services, observation services, outpatient surgery or lab work "and the doctor hasn't written an order to admit you to a hospital as an inpatient," then "you're an outpatient even if you spend the night in the hospital."
So a person who came through the emergency department on December 30, was held under observation on the 31st, and was formally admitted on January 1 was not an inpatient when their old plan ended. The December days are outpatient charges under the old plan, at the old plan's copays; the admission belongs to the January coverage. Neither outcome is a disaster — both are covered — but the deductible and the network that apply are different, and the way to know which one you are in is to ask. The question is "Have I been admitted as an inpatient, or am I under observation?" and it is worth asking every day a stay crosses the calendar line.
What the rule does not cover
Three limits, because the relief people feel when they read paragraph (c) tends to spread further than the paragraph does.
| Service | Does § 422.318 keep it with the old plan? |
|---|---|
| The inpatient hospital stay itself | Yes — an acute-care hospital, a psychiatric hospital, a rehabilitation hospital or unit, or a long-term care hospital, per paragraph (a). |
| A stay that began under observation | Only from the day a doctor writes the admission order. Observation nights are outpatient. |
| A skilled nursing facility stay that crosses January 1 | No — skilled nursing facilities are not on the paragraph (a) list. The new coverage's rules apply from its effective date. |
| Home health, therapy and follow-up visits after discharge | No — those are the new coverage's from day one. |
| Prescriptions filled after discharge | No — Part D runs on its own calendar. Check the new formulary before you are discharged, not after. |
Source: 42 CFR § 422.318(a) for the facility list; Medicare.gov — Medicare costs and the CMS 2026 fact sheet for the Part A figures.
- Skilled nursing is the big one. Paragraph (a) lists acute-care hospitals, psychiatric hospitals, rehabilitation hospitals and units, and long-term care hospitals. A skilled nursing facility is not on the list. If the hospital discharges you to a skilled nursing facility on December 29 and the facility stay runs into January, the December days are the old plan's and the January days are the new coverage's, on the new coverage's terms. Under Original Medicare that means days 1–20 at $0 and days 21–100 at $217 a day within a benefit period; under a Medicare Advantage plan it means that plan's copay schedule and, often, its authorization. Ask the facility's admissions office which coverage they will bill on January 1 before you agree to the transfer.
- Everything after discharge is January's. The surgeon's post-op visit, physical therapy, home health, a walker or oxygen — those are furnished after "the date of the beneficiary's discharge," and they belong to the plan or Original Medicare you hold that day. That is the reason the network check and the formulary check still have to happen before you enroll, even for someone the regulation protects in the hospital.
- The doctors' bills are a question to ask, not assume. The regulation speaks of "inpatient services" in the hospital. Physician and surgeon charges during the stay are billed separately from the hospital's, and how a given plan handles the professional charges that fall after its contract date is something to put in writing to both plans' member services. Keep the answers with the discharge paperwork.
The one thing not to do
Do not let the calendar make a medical decision. A December admission that runs past New Year's is paid to discharge by the December plan; a January admission is paid from day one by the January coverage. There is no gap between them and no reason to postpone a needed admission until "the new plan kicks in," or to push for a discharge before midnight on the 31st to avoid a bill that the regulation says will not arrive. If anyone at a hospital tells you the stay has to end because the plan is ending, ask the case manager to look at § 422.318(c) with you — that is what case managers are for.
The other thing not to do is nothing. The regulation protects the stay, not the year. Medicare.gov is explicit that if you do not pick a new plan, "you'll be enrolled in Original Medicare" — and Original Medicare on its own has, in Medicare.gov's words, "no yearly limit on what you pay out-of-pocket." A person who is discharged on January 6 into that default has the $283 Part B deductible, 20% of every outpatient bill with no ceiling, and no drug plan. We priced that door earlier this month; a hospital stay makes it more expensive, not less. If a stay keeps you from choosing during October 15 – December 7, the non-renewal Special Enrollment Period runs December 8 through the last day in February, and a discontinued plan also opens guaranteed-issue Medigap rights in Colorado.
Why this lands in Mesa County
Grand Junction is where the Western Slope goes to be admitted. The CMS hospital file lists Intermountain Health St. Mary's Regional Hospital and Community Hospital here, and the inpatient episodes that cross a calendar line — a cardiac admission, a fall, pneumonia in a bad winter week — mostly run through those two buildings, for people from Delta, Montrose, Rifle and Moab as well as the Grand Valley. Per CDC PLACES, 26.6% of Mesa County adults live with high blood pressure and 5.2% with coronary heart disease, which is the population most likely to meet this rule the hard way.
The local wrinkle is discharge destination. A patient from Grand Junction often goes home to a skilled nursing facility or a rehab unit outside the county, and that transfer is where the regulation's protection stops. Ask, before the transfer, whether the facility is a rehabilitation hospital or unit — which paragraph (a) covers — or a skilled nursing facility, which it does not, and which coverage the facility will bill on January 1. What we cannot tell you in September is which 2027 plans include which facilities. That data is published October 1, and the rule above does not depend on it.
What I would do this fall
If your plan is ending and a hospital stay is a real possibility this winter, I would make the January 1 choice during Annual Enrollment and not leave it to a family member in a waiting room. I would put a note in the folder that goes to the hospital — the new plan's card, the old plan's card, and one line: "if admitted before January 1, the old plan pays to discharge under 42 CFR 422.318(c)." I would ask about inpatient versus observation status on every day that touches the calendar line. And I would treat the post-discharge care — the follow-ups, the rehab, the prescriptions — as the part that actually depends on the plan I pick, because it is.
How we know all this: the Medicare On Main Data Desk frames every article with public data. The "responsible for the inpatient services until the date of the beneficiary's discharge" language, the "not made by original Medicare or by any succeeding MA organization" clause, the "date after the beneficiary's discharge" rule for coverage that begins mid-stay, and the facility list are quoted from 42 CFR § 422.318 on the Cornell Legal Information Institute mirror of the eCFR. The inpatient and outpatient definitions and the observation sentence are from Medicare.gov's hospital-status page. The 2026 Part A cost sharing ($1,736 per benefit period, $434 a day for days 61–90, $868 a day for lifetime reserve days, $217 a day for skilled nursing days 21–100), the $283 Part B deductible, the "no limit to the number of benefit periods" sentence and the "no yearly limit on what you pay out-of-pocket" sentence are from Medicare.gov's Medicare costs and inpatient hospital care pages, confirmed against the CMS 2026 Parts A and B fact sheet. The January 1 default and the December 8 – the last day in February Special Enrollment Period are quoted from Medicare.gov's Special Enrollment Periods page; the non-renewal notice description is from Medicare.gov's Plan Non-Renewal Notice page. Hospital names are from the CMS Hospital General Information dataset; county chronic-condition prevalence is CDC PLACES County Data 2023. No 2027 plan, premium, star rating, carrier or network detail is stated, because CMS has not published it. No carrier is endorsed or criticized; "the plan is being discontinued" is the whole of what a non-renewal means. This is education, not medical, legal or enrollment advice — confirm your own status and bills with the hospital, both plans and Medicare.gov.
Frequently asked questions
What happens if I'm in the hospital when my Medicare Advantage plan ends?
Your old plan keeps paying for the hospital stay until you are discharged, even though its contract ended December 31. That is federal regulation, 42 CFR § 422.318(c): when coverage under a Medicare Advantage plan ends while you are an inpatient, "the MA organization is responsible for the inpatient services until the date of the beneficiary's discharge," and payment for the rest of the stay "is not made by original Medicare or by any succeeding MA organization." Whatever you picked for January 1 — another plan or Original Medicare — takes over the day after you leave. The rule is for admitted inpatients in a hospital; it does not cover observation stays or a skilled nursing facility.
Who pays if my insurance changes in the middle of a hospital stay?
For Medicare, the coverage you had on the day you were admitted pays the inpatient stay through discharge. The same regulation works in both directions: if you move from Original Medicare into a Medicare Advantage plan on January 1 while admitted, "payment for inpatient services until the date of the beneficiary's discharge is made by ... original Medicare," and the new plan "is not responsible for the inpatient services until the date after the beneficiary's discharge." The bill does not split at midnight on December 31, and you do not owe two deductibles for one admission.
Does the Medicare Advantage plan that is ending still have to cover me in January?
For that inpatient stay, yes — until discharge. For everything else, no. Once the contract year ends, the plan "receives no payment for the beneficiary for the period after coverage ends," and the regulation limits its continuing duty to the inpatient services. Doctor visits, therapy, home health, equipment and prescriptions after you leave the hospital belong to whatever coverage you hold on January 1. If you did nothing, Medicare.gov says "you'll be enrolled in Original Medicare" — with no drug plan and no yearly cap on your 20%.
What is the difference between inpatient and observation status?
Medicare.gov draws the line at the doctor's order: "You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day." If you are getting emergency, observation or other hospital services and no admission order has been written, "you're an outpatient even if you spend the night in the hospital." The continuity rule in § 422.318 applies to inpatients only, so the first question to ask — out loud, at the nurses' station — is whether you have been admitted.
Should I put off a hospital stay until my new plan starts in January?
Not for this reason. A December admission that runs past New Year's is paid by the plan you had in December, all the way to discharge, and a January admission is paid by the January coverage from day one. There is no gap either way. The decisions that actually turn on the calendar are the ones after discharge — the surgeon's follow-up, rehab, home health and the prescriptions — which is why we check the 2027 network and formulary before enrolling, not after. Medical timing is between you and your doctor.
Does Medicare On Main charge for help if my plan is discontinued?
No. Brian Penner is an independent licensed Medicare advisor with 22+ years of experience, paid by the carriers, not by you. Our Grand Junction office is at 627 24 1/2 Rd Ste H — call (970) 644-6954. We do not offer every plan available in your area, and we'll tell you plainly when Medicare.gov, 1-800-MEDICARE or the hospital's case manager is the right next call.
Sources
- 42 CFR § 422.318 — Special rules for coverage that begins or ends during an inpatient hospital stay (Cornell LII mirror of the eCFR) — paragraphs (a), (b) and (c): the facility list, coverage that begins mid-stay, coverage that ends mid-stay.
- 42 CFR § 422.318 on the eCFR — the official text.
- Medicare.gov — Inpatient or outpatient hospital status affects your costs — inpatient versus observation, and the outpatient copay cap.
- Medicare.gov — Inpatient hospital care · Medicare.gov — Medicare costs (2026) — the 2026 Part A and Part B figures, benefit periods, and the no-yearly-limit sentence.
- CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet) — the same 2026 figures, from CMS.
- Medicare.gov — Special Enrollment Periods — the January 1 default and the December 8 – the last day in February window.
- Medicare.gov — Plan Non-Renewal Notice — what the letter is.
- Medicare.gov — Open Enrollment (October 15 – December 7) — the October 15 – December 7 window.
- CMS Hospital General Information (data.cms.gov) · CDC PLACES, 2023 — via the Medicare On Main Data Desk — Mesa County hospitals and chronic-condition prevalence.
