•  Triton College Annuitants Association

     Health Issues & Insurance

     

    Medicare “observation status” warning.

              In the last several months, I have reviewed several articles on the Medicare “observation status” which all of us should be aware of when we are going to the hospital. As I have read the various articles, it appears those Medicare administrators who complete audits of hospitals are applying some pressure on hospitals to place individuals in “observation status” and not “inpatient status." What this means is if you are going to the hospital and will be there more than one night, if they put you in “observation status,” Medicare may not be responsible for the cost; thus the bill becomes yours.

              Medicare treats “observations status” as the same as “outpatient.”  This type of visit is not covered under Medicare Part A. Instead, you are billed under Medicare Part B, so you must pay 20 percent of the bill for each service after reaching your deductible. You may also be charged with your medications while there and this is not covered under Part B. It would only be covered if you are covered under Part D or have a separate plan that covers your medications.

    Over the past six years the use of “observation status” has doubled in hospitals. The Federal Medicare auditors decide later the “inpatient status” should have been “outpatient.” When this happens, the hospital must return the Medicare payments received.

              What should you do if you are admitted to the hospital?

    1. Ask the case management department at the hospital to clarify your status. (Don’t be put off.)
    2. If it is “observational status,” ask your regular doctor to get your status changed to “inpatient status.” 

    If charged, then you need to appeal your charges which were not covered under Medicare Part A.  (An appeals kit may be downloaded free from MedicareAdvocacy.)


                                    

    Message from Eleonore Weber, Insurance Broker

      Bob Witherspoon and I are currently working together to gain a better understanding of the CMS recommendations for CIP Healthcare options starting on February 2014. It is our goal to comprehend the various plan recommendations, their benefits & features as well as all the possible gaps such as the deductibles and out of pocket costs.   How does the various CMS Med Advantage plans compare to the traditional Medicare Supplements and MedAdvantage Plans? Once you have those facts, the facts should assist you in the process of making a valuable healthcare decision easier starting this November 12, 2013.

    Just last week, I spoke with one of your TCAA member; we discussed exploring a competitive analysis for his wife’s current Medicare plan coverage.  Then, I pursued analyzing the same existing plan with the same benefits, hence I found several national companies that offer the same plan for a lower cost.  Consequently, it will allow them to save $600 a year just by switching their provider. THINK ABOUT THAT!

    Again, it is my goal to understand your budget, lifestyle and healthcare requirements, and pursue the best optimal fit to accommodate your needs. Please be patient, as we have time but please send me a note or call me should want to ask me any questions or make an appointment to review 2014 options.

    Eleonore Weber

    Licensed Insurance Broker-Disability, Health, Life and Long-Term Care 

    Your Life Security |Cell: (312) 952-1706 |

    Web site: www.YourLifeSecurity.com

     

    “HELPING PEOPLE SECURE AND PRESERVE THEIR ASSETS AND FUTURE”

      

     

    The College Insurance Plan provides health, dental, vision, and prescription coverage for SURS retirees.

    If you are a retiree who would like to enroll in this health insurance plan for you or your spouse or your dependent, this opportunity only comes once per year each May. For more info and rates, the website is: www.benefitschoice.il.gov.

     

    Medicare Part B premiums
    The Center for Medicare & Medicaid Services has announced that Medicare Part B premiums in 2014 will be $104.90, and the Part B deductible will be $147. Part A Deductible is $1,216 for 2014. Note that Part A and Part B premiums are on a sliding scale depending on income.

    Individuals who did not pay into social security or have some quarters (now known as credits) may receive Part A and B, but it is more expensive. Speak to your local Social Security Office.

    TCAA 
    Health/Quality of Life Newsletter   Health/Quality of Life Newsletter