Medicare Part A Benefit Period Deductible

[somarco]

Client entered hospice earlier this week. I understand hospice covered under Part A. Does the deductible carry over to the following year? Assuming yes since it would be the same benefit period.

Client has original Medicare and Medigap F. Spouse wants to drop the gap plan since she has been told that "Medicare will pay for everything".

Is that wise? Is it possible there will be OOP that would normally be covered by F or should she drop the plan to save the $200/mo premium?

 

[goillini52]

Client entered hospice earlier this week. I understand hospice covered under Part A. Does the deductible carry over to the following year? Assuming yes since it would be the same benefit period.

Client has original Medicare and Medigap F. Spouse wants to drop the gap plan since she has been told that "Medicare will pay for everything".

Is that wise? Is it possible there will be OOP that would normally be covered by F or should she drop the plan to save the $200/mo premium?

I think I'd tell them to keep the Med Supp.

"Important: Once you choose hospice care, the Medicare hospice
benefit should cover everything you need. Original Medicare will
still pay for covered benefits for any health problems that aren’t part
of your terminal illness and related conditions, but this is very rare."

"If you have a Medigap policy, it will cover your hospice costs for drugs
and respite care. Your Medigap policy will also help cover health care
costs for problems that aren’t part of your terminal illness and related
conditions. Call your Medigap policy for more information."

https://www.medicare.gov/pubs/pdf/02154.pdf

 

[somarco]

Wife left message so I knew what the call was about. Looked up hospice care before calling and mentioned what you just referenced. . . there may be charges subject to deductible and coinsurance/copay.

I feel she is being short sighted on this. She wants to save money. No one knows how long he will be in hospice or what his bills may be.

I did suggest she keep it. Also said if she wants to drop it she can but that is not what I would do.

 

[kgmom219]

Also, recommend that she speak with the Hospice provider and ask them what the out of pocket costs may be if her husband is on original Medicare only? That may help.

 

[somarco]

Supposedly it was the hospice folks that told her Medicare covers everything and she doesn't need the Medigap.

I have had several conversations with her this year and, frankly, am surprised her husband is still here. Someone at the hospital told her back in the spring she was paying too much for his F and he should get a different one.

Terminal esophageal cancer and apply for a new Medigap plan. Right . . .

I explained to her that he would not qualify for a new plan. Ran rates anyway and said if he COULD qualify she could only save about $20/month.

She told me she would check around and get back with me.

 

[LostDollar]

I think I'd tell them to keep the Med Supp.

"If you have a Medigap policy, it will cover your hospice costs for drugs
and respite care. Your Medigap policy will also help cover health care
costs for problems that aren’t part of your terminal illness and related
conditions. Call your Medigap policy for more information."

https://www.medicare.gov/pubs/pdf/02154.pdf

What he said + is there any chance of returns to hospital that would need the Med Supp expansion of lifetime reserve days?

(23 words, I'm over my quota. )

 

[MBSC]

Is it possible there will be OOP that would normally be covered by F...

If the person has to go to the hospital for an unrelated condition, Part A only covers the hospital facility fees. The beneficiary would be responsible for the Part B coinsurance on the inpatient professional charges billed to Part B without a Medigap.

Medicare Claims Processing Manual, Ch. 11, Section 50: "Any covered Medicare services not related to the treatment of the terminal condition for which hospice care was elected, and which are furnished during a hospice election period, may be billed by the rendering provider using professional or institutional claims for non-hospice Medicare payment."

2017 Part B deductible and coinsurance: $183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient). https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 

[LostDollar]

I've been trying to put myself into this situation and think about the decision from that perspective.

If a decision has been made by patient, patient's lay support and patient's medical support for the patient to go into hospice because of a terminal condition, what is the real world experience and the real world chance that the patient would have to go back to the hospital?

Say the patient gets pneumonia or has a heart attack. Since the patient has been sent to hospice for a terminal condition, wouldn't they just continue with palliative care for the new conditions too, rather than returning the patient to the hospital? So there would continue to be only hospice type charges? And the primary condition itself receives the hospice charges. So wife just has to find money for $5 prescription charges and 5% of respite care.

Have you seen client situations where the patient was returned to the hospital from hospice for unrelated conditions? Or would the doctors itemize bills from the hospice bedside in 2 parts: examine patient's esophagus for cancer-x hours and examine patient's chest for heart attack- y hours?

 

[somarco]

If the person has to go to the hospital for an unrelated condition, Part A only covers the hospital facility fees. The beneficiary would be responsible for the Part B coinsurance on the inpatient professional charges billed to Part B without a Medigap.

Medicare Claims Processing Manual, Ch. 11, Section 50: "Any covered Medicare services not related to the treatment of the terminal condition for which hospice care was elected, and which are furnished during a hospice election period, may be billed by the rendering provider using professional or institutional claims for non-hospice Medicare payment."

2017 Part B deductible and coinsurance: $183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient). https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

What are the odds of someone in hospice being admitted to the hospital?

 

[rcduggan]

200/m premium F plan vs an MAPD OOP. i'll take the F plan all day