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Hospitalization, Skilled Nursing and Medicare

Recently, in one 48-hour period, I received similar questions from caregivers. These caregivers were not related, and they did not know one another. Each was the adult child whose parent was about to be discharged from a skilled nursing facility. Though they were very informed and had been through the hospital to skilled nursing to home process before, they were each a little unsure about their options, and wanted to be sure they did right by their parent. Their questions had to do with skilled nursing facilities, Medicare, covered days, and finally home health care options. It led me to lay out some of the information so that others could benefit. Below are the 2017 Medicare hospital and skilled nursing facility benefits. This information does not cover every aspect of the subject, but it is a start.

Medicare Part A Hospital Expenses*

Member Deductibles:

Members will have a $1316 deductible per benefit period. A benefit period starts the day you are admitted to a hospital or skilled nursing facility, and ends after you have not been in the hospital or SNF for 60 consecutive days.

Member Co-payments:

  • $0/day for days 1-60
  • $329/day for days 61-90 in hospital per benefit period.
  • $658/day for days 91-150 in hospital per benefit period (Lifetime Reserve Days).
  • No coverage after day 150 in hospital (or day 90 if Lifetime Reserve Days previously used).

Skilled Nursing Facility Expenses*

  • Full coverage of expenses in skilled nursing facility for days 1-20 when this follows a 3-day hospitalization during each benefit period.
  • $164.50/day for days 21-100 in a skilled nursing facility during each benefit period.
  • No coverage after day 100 in skilled nursing facility during each benefit period.

*Hospital and Skilled Nursing Facility daily co-pays may be covered by your Medigap policy or other commercial secondary insurance coverage.

 

 

 

Enrolling in Medicare with an Employer Health Plan – Who Pays First?

Recently, I received the following question from a reader:

“I have health insurance through my employer, my husband is self-employed. Will my insurance still be the primary insurance when my husband turns 65 and applies for Medicare?”

Suspecting this could be a complicated question, I went to the medicare.gov website to research the answer. Not too much longer I believe I found the answer in their publication CMS #02179, dated August 2015, “Your Guide to Who Pays First.”

In both the chart that starts on page 6, and in the text on page 12, they refer to such a scenario, answering that when one is 65 or older and covered by a group health plan of either oneself or one’s spouse, and the employer has 20 or more employees, the group health plan pays first, and Medicare second. When the employer has less than 20 employees, then Medicare would be the first payor.

This publication is worth a look because there are many more scenarios to consider. It is available for download on the medicare.gov website here. If you prefer to someone directly, call 1-855-798-2627.

 

Medicare Announces Year 2016 Part B Premiums

This week, the Centers for Medicare and Medicaid announced the year 2016 Medicare Part B premiums. Much discussion and lobbying preceded the announcement, mostly due to the threat of large increases and a lack of a Social Security Cost of Living Adjustment. In the end, some premium amounts changed, while others did not.

 

Click here for the chart, and then find your income level on the 2016 chart to determine your premium amount for 2016.

 

Additionally, the annual deductible for Part B is rising, from $147 per year to $166.

2013 Medicare Premium Rates

In 2013, the premium rate for Medicare Part B is $104.90, for most enrollees.  The rate changes if your income is above $85,000 for an individual, or $170,000 for a couple.  The Part B deductible is $147.00 in 2013.  More info can be found at the Medicare.gov website.

 

 

You Don’t Have To, But…

In the work I do with people who receive VA benefits and are also eligible for Medicare Part B, I am often asked if they should enroll in Part B.  “After all, it costs $99.90 a month (current rate), and if I have VA healthcare benefits and use the VA hospital system, do I really need it?” I am asked.

And the answer is, “No, you don’t have to, but” (and this is where the list starts):

  • If you ever use medical services outside the VA system, Medicare Part B will help you cover those costs.  VA covers services within the VA system.
  • Delaying your initial enrollment for Medicare Part B can cost you in penalties.  Monthly premiums increase 10 percent for each 12-month period a person is eligible but did not enroll.  The longer one waits, the higher the premium gets.
  • If the monthly premium for Medicare Part B is beyond your budget, you might want to look into your state’s Medicare Savings Program.

Two good phone numbers to have are Social Security: 1-800-772-1213, and VA Health Benefits:  1-877-222-8387.  Representatives at these numbers can be very helpful in sorting through these questions.

New Medicare Changes in Your Mailbox

Not a month goes by that I don’t have someone handing me a copy of their Medicare Summary Notice and asking me to help them decipher what it says.  Needless to say, it is long, complicated and confusing.  Often, the question I get is “Do I owe them any money?”  While these notices are just notices, and not bills, I get concerned that people choose not to review them.  I always remind people that getting these notices is a good chance to review the information to be sure it records procedures and physician appointments that actually happened.  For some, I am the one who reviews the information to be sure of accurate billing.  At least twice in the last year I discovered inaccurate billing.  In these cases they did not amount to a different dollar amount, but it was still important to call and inform Medicare of the errors.

Now, in an effort to make the notice more consumer-friendly, and encourage members to review each notice to catch errors or possible fraud, Medicare has revised the notice, and beginning next year, will start using the new and improved notice for their 36 million beneficiaries.  The new consumer-friendly format can be viewed at Medicare Summary Notice.  Still long, especially for those with chronic health problems and frequent medical appointments, it should be easier to review and understand, and thereby identify and report any fraudulent activity.