Do I Have to Pay This Bill?

“…in this world nothing can be said to be certain, except death and taxes.” To this list of life’s certainties attributed to Benjamin Franklin, we might also add bills. While the season of gift catalogs and holiday greetings is nearly upon us, our mailboxes are perennially filled with notices of balances due from utility companies, credit card providers, and medical offices, among many others.

When it comes to medical bills, there is often confusion about what we are responsible to pay, what should be covered by insurance, Medicare or supplemental Medicare plans, and whether other arrangements can be made.

Care Answered works with our clients before they have a medical encounter to ensure that planned services and providers will be covered by their insurance.  If you receive an unexpected bill after services are rendered by a healthcare provider, our best advice is to not automatically pay it before asking a few questions.

If you believe you received a bill for a medical encounter that should have been covered by insurance, contact your insurance provider and ask them specifically why they did not pay it. If the services provided are unclear, call the provider and ask for a detailed, itemized bill. If something listed on your bill is unclear to you, ask what it is.

Long-term skilled nursing facilities (A.K.A. nursing homes) should not bill patients who are covered by Medicaid. If your loved one has been approved for nursing home Medicaid and you receive a bill for their care, you may not be responsible to pay it.

Bills are generated by people working in billing departments; they are human and sometimes make mistakes so it always pays to check your bills carefully. If you feel you need an advocate because the billing seems wrong or if you want to make sure you don’t get charged before you go, contact Care Answered or call us at (516) 584-2007.

Untangling healthcare bills can be daunting, especially when you should be focusing on getting better.  We can help.

Medicare Open Enrollment Begins October 15

Monday, October 15 begins the Open Enrollment period for 2019 Medicare. Between October 15 and December 7, you may enroll in Medicare if you became eligible in the past but did not enroll. You may also use this time to make changes to your enrollment. For example, you can switch from traditional Medicare to a Medicare Advantage Plan, change from one Medicare Advantage Plan to another, or change from one prescription drug (Part D) plan to another.

Start by reviewing your coverage. The Medicare website has a host of resources to help you learn more about plans and options so that you can evaluate your needs and select the plan that is best for you. One helpful resource is the Medicare Plan Finder tool which will help you find plans offered in your area.

There will be changes to Medicare beginning in 2019, including elimination of the so-called “donut hole” for prescription drug costs, one year ahead of schedule. Premium rates have not yet been announced, but an increase is projected. Additionally, the income threshold for the highest premium bracket has increased to $500,000 for an individual and $750,000 for a couple, up from $160,000 per individual and $320,000 per married couple.

For additional information or help navigating the complexities of Medicare, don’t be afraid to call on a professional. There are insurance brokers, healthcare advocates and others who can help you sort it all out and select the plans that are most appropriate for your individual situation. Many libraries and community based organizations can connect you with free resources. Want to learn more? Give me a call at 516-584-2007.

Hospital coverage through Medicare

Hospital coverage through Medicare

Nursing Home or Rehabilitation; doesn’t Medicare pay for that?

 

So often questions about Medicare coverage for rehabilitation come up after the fact so let me address one of the most common questions here. When you or a loved one leaves the hospital you are likely relieved or thinking of the next steps of care; but so often patients and their families are bewildered and overwhelmed about the lack of insurance coverage for rehabilitation and/or skilled nursing care. If you are 65 or over you likely have Medicare coverage A and B. So here are some basic facts about Medicare coverage for rehabilitation or skilled nursing care:

Medicare coverage part A is “hospital insurance” covers skilled nursing or rehab care ONLY after:

You meet the 3 DAY impatient hospital stay. This means you must be FORMALLY ADMITTED to the hospital. IF you are in the emergency room for 3 days but not admitted to the hospital you will not receive insurance coverage for your rehabilitation or skilled nursing care.

Even if you feel you have great insurance to fill in the gaps of Medicare A and B coverage without that 3 day hospital admittance there is likely no insurance that will cover your rehabilitation or skilled nursing care.

What do you do? You need an advocate who can ascertain from your healthcare team if you will be admitted, help determine your choices and advocate for your hospital admittance. And plan ahead

Below are some original Medicare costs and link here for more info on Medicare Part A hospital and skilled nursing facility coverage. Remember that even when you receive Medicare part A coverage for hospital or skilled nursing care it may not fully cover for the length of stay needed.

Your costs in Original Medicare

You pay:

  • Days 1–20: $0 for each benefit period.
  • Days 21–100: $161 coinsurance per day of each benefit period.
  • Days 101 and beyond: all costs