basic question on Parts A & B

[Nemo]

In a discussion among US expats about the pros and cons of signing up for Medicare, a user claimed that by registering only for Part A he could return to the US at some time in the future and be admitted for treatment to a hospital paid for by Medicare. My understanding is that without Part B, Medicare Advantage or some other insurance that would assure the hospital that you can pay for the doctors' services they would not admit you.

Who is correct?

 

[mattspits]

In a discussion among US expats about the pros and cons of signing up for Medicare, a user claimed that by registering only for Part A he could return to the US at some time in the future and be admitted for treatment to a hospital paid for by Medicare. My understanding is that without Part B, Medicare Advantage or some other insurance that would assure the hospital that you can pay for the doctors' services they would not admit you.

Who is correct?

I'm sure you understand what services Medicare Part A and Part B cover based on the wording of the question. I believe the answer depends on the hospital. I'm assuming if the procedure is voluntary, the hospital will be looking for some kind of payment up front or payment plan at least.

 

[JC]

If it is an inpatient hospitalization covered by part A everything that happens during that hospitalization is covered under part A including the Drs and prescriptions. However he would be responsible for the $1288 deductible and any per day copays required by part A. Part B is for Outpatient medical coverage.

 

[MBSC]

If it is an inpatient hospitalization covered by part A everything that happens during that hospitalization is covered under part A including the Drs and prescriptions. However he would be responsible for the $1288 deductible and any per day copays required by part A. Part B is for Outpatient medical coverage.

An inpatient hospital stay involves facility fees (including prescriptions) billed on an electronic version of the UB-04 claim form and processed under Part A. But, it also includes professional fees (surgeon, anesthesiologist, etc.) billed on an electronic version of the CMS-1500 claim form and processed under Part B. This creates both Part A and Part B cost sharing.

"Part B also covers most doctor services you receive as a hospital inpatient."
Source: http://advantages.aarp.org/en/healt...ptions/medicare-part-b-medical-insurance.html

"If a doctor's services are billed separately from hospital inpatient charges, Medicare Part B covers the doctor's services regardless of where the patient receives the care."
Source: https://www.caring.com/medicare_information/medicare-coverage-of-physician-services


"Costs for inpatient hospital care

When you are admitted to a hospital as an inpatient, you pay a one-time deductible for most hospital care provided, and then have no copayments for the first 60 days. Medicare Part A covers nurse’s services, medically necessary medications, X-rays, supplies, appliances, and equipment the hospital provides for you to use during your inpatient hospital stay. Medicare Part B covers doctors’ services you receive in the hospital. You usually owe a separate 20 percent coinsurance for these doctors’ services."
Reference: http://www.medicareinteractive.org/...d-costs-if-you-stay-in-the-hospital-overnight

"Medicare Part A covers a medically necessary inpatient hospital stay, plus all care provided to the patient by hospital staff and facilities related to that stay.
Medicare Part A doesn't cover care in the hospital by a doctor (such as a surgeon, radiologist, anesthesiologist, oncologist, or other treating physician) who isn't on the hospital staff; those services are covered instead by Medicare Part B."
Reference: https://www.caring.com/medicare_information/medicare-coverage-of-hospital-inpatient-care

 

[JC]

Personally I have run into to many articles written by "experts" that just provide inaccurate information. I prefer going directly to the source. Here is the Medicare Benefit Policy Manual found on CMS.GOV for Part A hospital coverage that explains exactly how it works and what is billed. Its a lot of reading about specific situations. Have at it

 

[MBSC]

We can agree to disagree.

Medicare Benefit Policy Manual;

Chapter 1 - Inpatient Hospital Services Covered Under Part A

Section 1 – Definition of Inpatient Hospital Services

B. Inpatient hospital services does not include the following types of services:

3. Physician services that meet the requirements of 42 CFR 415.102(a) for payment on a fee schedule basis.
4. Physician assistant services, as defined in §1861(s)(2)(K)(i) of the Act.
5. Nurse practitioner and clinical nurse specialist services, as defined in §1861(s)(2)(K)(ii) of the Act.
6. Certified nurse mid-wife services, as defined in §1861(gg) of the Act.
7. Qualified psychologist services, as defined in §1861(ii) of the Act.
8. Services of an anesthetist, as defined in 42 CFR 410.69.

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2016 Medicare & You

Hospital care (inpatient care)

If you have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.
Reference: https://www.medicare.gov/Pubs/pdf/10050.pdf

Medicare Basics

Everyone with Medicare can get this inpatient hospital care:
• General nursing
• Semi-private room
• Doctor’s services you get while you’re in a hospital (if you have Part B).
• Meals and supplies
Reference: https://www.medicare.gov/Pubs/pdf/11034.pdf


Situation: You're formally admitted to the hospital with a doctor's order.

Part A pays: Your inpatient hospital stay
Part B pays: Your doctor services
Reference: https://www.medicare.gov/what-medicare-covers/part-a/inpatient-or-outpatient.html

Part B deductible & coinsurance

You pay $166 per year for your Part B deductible. 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).
Reference: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html

Medicare 2016 costs at a glance

Part B deductible and coinsurance: $166 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.
Reference: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Under the Medicare Fee-for-Service program, hospitals and physicians are paid separately for care provided in hospitals under Part A and Part B, respectively, which adds to the misalignment between the incentives facing hospitals and those facing physicians.
Reference: https://innovation.cms.gov/files/reports/dra5007-report-to-congress.pdf

 

[JC]

We can agree to disagree.

Medicare Benefit Policy Manual;

Chapter 1 - Inpatient Hospital Services Covered Under Part A

Section 1 – Definition of Inpatient Hospital Services

B. Inpatient hospital services does not include the following types of services:

3. Physician services that meet the requirements of 42 CFR 415.102(a) for payment on a fee schedule basis.
4. Physician assistant services, as defined in §1861(s)(2)(K)(i) of the Act.
5. Nurse practitioner and clinical nurse specialist services, as defined in §1861(s)(2)(K)(ii) of the Act.
6. Certified nurse mid-wife services, as defined in §1861(gg) of the Act.
7. Qualified psychologist services, as defined in §1861(ii) of the Act.
8. Services of an anesthetist, as defined in 42 CFR 410.69.

-------
2016 Medicare & You

Hospital care (inpatient care)

If you have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.
Reference: https://www.medicare.gov/Pubs/pdf/10050.pdf

Medicare Basics

Everyone with Medicare can get this inpatient hospital care:
• General nursing
• Semi-private room
• Doctor’s services you get while you’re in a hospital (if you have Part B).
• Meals and supplies
Reference: https://www.medicare.gov/Pubs/pdf/11034.pdf


Situation: You're formally admitted to the hospital with a doctor's order.

Part A pays: Your inpatient hospital stay
Part B pays: Your doctor services
Reference: https://www.medicare.gov/what-medicare-covers/part-a/inpatient-or-outpatient.html

Part B deductible & coinsurance

You pay $166 per year for your Part B deductible. 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).
Reference: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html

Medicare 2016 costs at a glance

Part B deductible and coinsurance: $166 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.
Reference: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Under the Medicare Fee-for-Service program, hospitals and physicians are paid separately for care provided in hospitals under Part A and Part B, respectively, which adds to the misalignment between the incentives facing hospitals and those facing physicians.
Reference: https://innovation.cms.gov/files/reports/dra5007-report-to-congress.pdf

Sorry didn't mean to say I was disagreeing with you are the validity of the articles you posted. I was just providing the Medicare manual to find that information. I just don't trust what other people write without the evidence to back it up.

I ran across an article last week written by a very credentialed individual in senior levels of the organization tasked with helping seniors. In this article she listed all the things that were covered in the TrOOp for RX. In there she claimed that the premium, over the counter meds, along with many many other things counted towards TrOOp. Any agent doing this long enough knows how wrong that is.

So again sorry didn't mean to come across that way. Just providing the actual documentation to back up what you were saying.