Medicare Q&A
Posted on July 2, 2015 by bob in Medicare
Dear Marci,
I was in the hospital recently, but my hospital visit was covered under Part B instead of Part A. Someone told me that I was probably under observation during my hospital stay. What is an observation stay? — Robin
Dear Robin,
During an observation stay, your doctor decides to keep you in the hospital to monitor your conditions and determine whether you need to be admitted as an inpatient. Observation stays are considered outpatient hospital stays, and most of the services you receive are covered under Part B; inpatient hospital stays are covered under Part A. The costs associated with an outpatient observation stay are different than those associated with an inpatient stay, and you may have higher out-of-pocket costs for services received during an observation stay.
Observation stays can last just a few hours or longer. If your doctor expects you to need care for an amount of time that crosses two or more midnights in the hospital, the doctor should formally admit you as an inpatient. If you are under observation as an outpatient, you will have two types of costs after you meet the Part B deductible. You will typically pay a copay for each medical service you receive in the hospital, which will vary in cost depending on the service. You must also pay a 20 percent coinsurance for physician services you receive as an outpatient.
Observation stays can look and feel just like inpatient stays. Know that staying overnight in the hospital does not make you a hospital inpatient. You only become an inpatient after a doctor signs an order to formally admit you to the hospital. You can ask your doctor at the hospital whether your status is inpatient or whether you are receiving observation care. Your status may change during your stay, so it is important to ask regularly.
Dear Marci,
I have a Medicare Advantage HMO plan that includes prescription drug coverage. Do I also have to have a Part D plan? — Rebecca
Dear Rebecca,
No, if you have a Medicare Advantage HMO plan that includes prescription drug coverage, you do not have to sign up for a separate, stand-alone Part D plan.
There are two ways to get Medicare Part D prescription drug coverage. You can enroll in a stand-alone Part D plan that works with your Original Medicare coverage to pay for your prescription drugs, OR you can enroll in a Medicare Advantage plan that includes prescription drug coverage in the plan.
Consider your health care and drug needs when choosing how to get your prescription drug coverage. You can contact 1-800-Medicare to discuss your prescription drug coverage and what plans are available in your area.
Dear Marci,
I receive $1,300 each month from my Social Security retirement benefits. This is my only source of income, and I have about $10,000 in assets. Do I qualify for Extra Help? — John
Dear John,
Yes, based on your income and assets, you will likely qualify for Extra Help. Extra Help is a federal assistance program that helps to pay Medicare prescription drug costs for people with limited incomes.
In 2015, individuals who receive less than $1,471 in income each month and have up to $13,640 in assets should qualify for Extra Help. Married couples who receive less than $1,991 in income each month and up to $27,250 in assets should qualify for Extra Help.
Know that if you have Medicaid, a Medicare Savings Program, or receive Supplemental Security Income (SSI), you should automatically receive Extra Help.
You can apply for Extra Help online by visiting www.ssa.gov. You can also apply by calling the Social Security Administration at 1-800-772-1213 or by visiting your local Social Security office.
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, visit http://action.medicarerights.org/resources. Click on Newsletters.
