Medicare Coverage and Medigap Insurance for Hospital Stays

KOT1 TASK 2 SCENARIO ONE Medicare part A is the hospital insurance and it will pay your mother's hospital bill one hundred percent because she has met the three day minimum hospital stay criteria. That cost will include room and board and services such as lab work, any therapy she may have received during her stay as well as pharmacy. Since your mother also has Medicare part B which is the medical insurance, part B will pay eighty percent of the physician’s services as long as her annual deductable has been paid.

Unless your mom has supplemental insurance coverage also known as Medigap insurance, she will be financially responsible for the twenty percent that part B Medicare does not cover. A Medicare supplement referred to as (Medigap) insurance, sold by private insurance companies, can help pay some of the costs that Medicare doesn't cover. Medicare. gov[11/04/12]www. medicare. gov/supplement-other-insurance/medigap/whatsmedigap. htm. A couple of examples of Medigap insurance companies are AARP, Humana, and Agis. You will have to pay the private insurance company a monthly premium for your Medigap policy just as you would any insurance policy.

Keep in mind that premium will be in addition to the monthly Part B premium that you pay to Medicare. In order to qualify you must have Medicare part A and B. That maybe something you and your mother may want to look into. Regarding her moving to the skilled nursing facility, the cost will be covered by Medicare one hundred percent the first twenty days. After a hospital stay of at least three days, your mother's stay in a Medicare-certified Skilled Nursing Center can be covered at 100% for the first 20 days. For the next 80 days, if your mother had to stay that long Medicare Part A covers everything except the daily coinsurance.

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I'm sorry no one informed either of you that your mother got an infection while at the nursing facility. That information should have been disclosed to the both of you. Unfortunately because your mother acquired and infection while at the skilled nursing facility, she had to receive additional care including antibiotics. Medicare will not pay the additional expense and your mother fortunately will not be billed either. This is considered a preventable event. The facility will have to pay the costs of treatment for infection. In 2009 the rules have changed.

So for instance, if you are on Medicare and you get a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Paddock, C (2007, Aug 20) Medicare will not pay for hospital mistakes and infections, new rule, Medical News Today, p1. This is unfortunate for the general public because where Medicare will not pay for these costs the costs is shifted. Unpaid costs must be covered by those who do pay so the hospital can continue operating, a process known as cost shifting.

Providers increase their charges against households and public and private insurers who pay for their own care plus make some contribution for the care of the uninsured population. This increases insurance premiums, making it even more difficult for many households and businesses to afford healthcare coverage. In January 2006, Medicare added access to a prescription medication benefit which is Medicare part D in which your mother is enrolled. Your mothers out of pocket prescription drug costs are calculated on a progressive basis (like federal income tax). She will pay the first $325 which is the Medicare Part D Plan deductible.

After the deductible is met, she will pay 25% co-insurance towards all the prescription drug costs up to a total of $2970. For example, let us assume that her total yearly prescription drug expenses are $3000. Therefore, she will pay 25% of the difference between the deductible ($325) and $2970 which is: (2970 - 325)*0. 25 = $661. 25. When the costs total more than $2970, she will be responsible for 100% of the difference between $2970 and $3000 or an additional cost of $30. In this example the total estimated annual cost out of pocket for prescription drug plan with a Medicare Part D should be around: $325 + $661. 5 + $30 = $1016. 25 in addition to the monthly premiums your mother will have to pay for the part D plan. In summary Medicare part A will pay your mothers hospital stay one hundred percent as long as the deductable is met. She will also pay twenty percent of the medical bill as long as her deductable is met. Medicare will pay for rehabilitation services one hundred percent excluding the charges for the care of the urinary tract infection. After the deductible is met, she will pay 25% co-insurance towards all the prescription drug costs up to a total of $2970.

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