Marci's Medicare AnswersJuly 2012
Dear Marci,
I have Original Medicare. Will Medicare cover my hepatitis B vaccine?
—Iris
Dear Iris,
Part B of Original Medicare will cover your hepatitis B shots if you are at medium to high risk for hepatitis B. As long as you see doctors or providers who accept assignment, the hepatitis B vaccine will be available at no cost. If you are at low risk for hepatitis B, the shots will not be covered under Part B, and will instead be covered under Part D.
People who are considered at high or medium risk for hepatitis B are:
- Those with End-Stage Renal Disease (ESRD), also known as kidney failure
- Those who live in the same household as a hepatitis B carrier
- Homosexual men
- Health care professionals who have frequent contact with blood or other bodily fluids during routine work
This year, Medicare private health plans, also known as Medicare Advantage (MA) plans, must cover hepatitis B shots the same way that Original Medicare does. If you have an MA plan, your costs may vary depending on whether you see an in-network or out-of-network provider. You should call your plan to find out what other rules apply.
—Marci
Dear Marci,
I am about to be discharged from a hospital, but I feel I am not well enough to leave. Can I appeal the hospital’s decision to discharge me?
—Elaine
Dear Elaine,
If you feel that you are being asked to leave the hospital (discharged) before you are well enough to go, you can ask for an immediate (expedited) independent review of your case. It is a good idea to ask your doctor for support.
If you make a formal request for an immediate review within the proper timeframe, the hospital cannot force you to leave before a decision has been made. You should be able to stay in the hospital at no charge while your case is being reviewed. Even if it is ultimately decided that you do not need continued hospital care, the hospital cannot charge you for any care received until noon of the next calendar day after you get the review decision.
Prior to being discharged, the hospital will give you a copy of a notice called anImportant Message from Medicare, which describes your rights as a patient. This notice will tell you how to contact the Quality Improvement Organization (QIO) to request an immediate review of the hospital’s decision to discharge you.
To get an expedited review, you must contact the QIO by midnight of the date you are being discharged (and before you leave the hospital). The QIO will inform the hospital of the appeal right away (that day or first thing the next morning if the request is received after the QIO has closed.)
Appealing to the QIO is the first step in the hospital discharge appeals process. The higher levels of this process vary depending on whether you are enrolled in Original Medicare or a Medicare Advantage plan.
—Marci
Dear Marci,
My income is a bit higher than the limit to qualify for a Medicare Savings Program. Should I still apply?
—Amber
Dear Amber,
Yes. If your income is above the income and/or asset guidelines, you should still apply. You may still qualify for a Medicare Savings Program (MSP) because certain income and assets may not count. Keep in mind that MSPs are administered by each state. How your income and assets are counted to determine eligibility varies from state to state. Contact your State Health Insurance Assistance Program (SHIP) for more information on your state’s eligibility guidelines.
—Marci
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.
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