Observation Care and Supplements

[rousemark]

Have not been active in Med Supp production for many years. One of the changes to medicare is the "Observation Care" I understand that this type of care is covered as part B expenses.. Is that correct? Does a medicare Supplement such as Plan F pay what Medicare does not pay?

 

[kgmom219]

"Under Observation" is a new term that Medicare decided would be fun!

1. It does NOT count towards the 3 day rule with regards to SNF. If you are moved to an SNF, without 3 days of Inpatient, there is no coverage at the SNF
2. Any drugs received while classified as under observation are covered under Part D. So the pills that cost $.10 at Walmart cost $5 per pill while at the hospital. (I tell my clients to take their drugs in the original bottles if at all possible)
3. Other charges are covered under F, G, and N.

Hope this helps!

 

[rousemark]

"Under Observation" is a new term that Medicare decided would be fun!

1. It does NOT count towards the 3 day rule with regards to SNF. If you are moved to an SNF, without 3 days of Inpatient, there is no coverage at the SNF
2. Any drugs received while classified as under observation are covered under Part D. So the pills that cost $.10 at Walmart cost $5 per pill while at the hospital. (I tell my clients to take their drugs in the original bottles if at all possible)
3. Other charges are covered under F, G, and N.

Hope this helps!

Thanks.. So if you have original Medicare and a Med supp, you do not have too much exposure unless you are transferred to an SNF.? I was trying to decide what products might fill coverage gaps the most. It would appear that if a good STC plan might be best, especially since it covers all levels of care.

But if a person has an advantage plan, would the premium not be better spent on an HI plan? How often does observation care happen?

 

[kgmom219]

Thanks.. So if you have original Medicare and a Med supp, you do not have too much exposure unless you are transferred to an SNF.? I was trying to decide what products might fill coverage gaps the most. It would appear that if a good STC plan might be best, especially since it covers all levels of care.

But if a person has an advantage plan, would the premium not be better spent on an HI plan? How often does observation care happen?

I have no idea how MA works.

There isn't that much exposure on the SNF. I just think its important to tell clients of potential pitfalls. The hospitals get it now and are helping to limit tgat exposure. I hear about drug bills about once a month, though

 

[HowdyDoody]

Thanks.. So if you have original Medicare and a Med supp, you do not have too much exposure unless you are transferred to an SNF.? I was trying to decide what products might fill coverage gaps the most. It would appear that if a good STC plan might be best, especially since it covers all levels of care.

But if a person has an advantage plan, would the premium not be better spent on an HI plan? How often does observation care happen?

Yes, GTL and Medico's HI policies cover Observation Days. Seems like Equitable's does too. These plans are designed to go along with MA plans. I think GTL's is the best. You can even add DVH.

 

[rousemark]

Yes, GTL and Medico's HI policies cover Observation Days. Seems like Equitable's does too. These plans are designed to go along with MA plans. I think GTL's is the best. You can even add DVH.

But if the person has a medicare supplement, it along with medicare will pay all the medical expenses; they have no real exposure with the observation days. Therefore it looks like spending any additional money they want to spend would be put to better use with the STC (Equitable has a good one) instead of the Hospital Indemnity product.

 

[HowdyDoody]

But if the person has a medicare supplement, it along with medicare will pay all the medical expenses; they have no real exposure with the observation days. Therefore it looks like spending any additional money they want to spend would be put to better use with the STC (Equitable has a good one) instead of the Hospital Indemnity product.

I agree with you, but you asked about HI to go with MA and that's what I responded to.

 

[rousemark]

I agree with you, but you asked about HI to go with MA and that's what I responded to.

I know and I appreciate your response.. But I was wanting to make sure I had a proper understanding of both scenarios.. Org. Medicare with a supplement or MA.. As you knwo I am an old guy.. takes a while for things to sink in.

 

[HowdyDoody]

I know and I appreciate your response.. But I was wanting to make sure I had a proper understanding of both scenarios.. Org. Medicare with a supplement or MA.. As you knwo I am an old guy.. takes a while for things to sink in.

No problem. I think Equitable has the best Short Term Care policy, but Medico's is better priced. I know what you mean about getting older. I'm getting close to needing a Med Supp myself. lol

 

[rousemark]

No problem. I think Equitable has the best Short Term Care policy, but Medico's is better priced. I know what you mean about getting older. I'm getting close to needing a Med Supp myself. lol

Been there for awhile.