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Marci’s Medicare Answers

July 2014

 

Dear Marci,

What is the difference between a hospital inpatient and hospital outpatient?

—Patrick 

Dear Patrick,

This is a great question. A hospital inpatient is a patient who has been formally admitted into the hospital by a hospital doctor. If a patient has not been formally admitted into the hospital as a hospital inpatient, then he/she is generally considered to be an outpatient. For example, if you are receiving care in the emergency room, you are generally considered to be a hospital outpatient, since patients in the emergency room generally have not been formally admitted into the hospital as a hospital inpatient.

If you are in the hospital, it’s important for you to know whether you are considered to be a hospital inpatient or outpatient, since this affects the way in which Medicare pays for hospital care you receive.

Medicare Part A, the hospital insurance part of Medicare, covers inpatient hospital care. If you have Original Medicare, the traditional Medicare program administered directly through the federal government, you pay a one-time deductible for your inpatient hospital stay under Part A. You also do not have to pay a copayment or copay for the first 60 days of your inpatient hospital stay.

Medicare Part B, the medical insurance part of Medicare, covers outpatient care. If you have Original Medicare, Part B generally covers 80 percent of the cost of Medicare-covered health care services you receive and you are responsible for the remaining 20 percent coinsurance. Note that if you get your Medicare benefits through a Medicare Advantage plan, also known as a Medicare private health plan, your costs and coverage may differ depending on your plan’s rules.

It’s best that you or a caregiver ask the hospital staff whether you are a hospital inpatient or outpatient during your hospital stay, so you can know how Medicare covers your hospital care. In addition, know that people with Original Medicare must have a 3-day inpatient hospital stay in order for Medicare to cover skilled nursing facility care after their hospital stay. Keep in mind that this may not apply to those who get their Medicare benefits through Medicare Advantage plans. Again, those with Medicare Advantage plans should contact their plan directly to learn more about their plan’s benefits, costs and rules.

—Marci

 

Dear Marci,

Will Medigap plans be sold through the Health Insurance Marketplaces?

—Marcus

Dear Marcus,

No. Medigap plans, which are supplemental insurance plans that help pay out-of-pocket Original Medicare costs like deductibles and coinsurances, will not be sold through the Health Insurance Marketplaces. In addition, Medicare Advantage plans and Medicare prescription drug plans will not be sold through the Marketplaces.

Health Insurance Marketplaces were created by the Affordable Care Act as a way for uninsured or under-insured individuals to purchase health insurance. In general, people with Medicare should keep their Medicare coverage and should not purchase health insurance plans through the Marketplaces.

If you would like to learn more about different Medigap plans in your area, you can contact your local State Department of Insurance. If you would like to get more information about Medicare Advantage plans or Part D plans in your area, you can contact 800-MEDICARE or go online and visit www.medicare.gov. You can also contact your local State Health Insurance Assistance Program (SHIP) to learn more about your Medicare options. To find the contact information for your local SHIP, you can go online and visit www.shiptalk.org.

—Marci

 

Dear Marci,

I have had Medicare for a few years and recently got Medicaid. I also received a notice saying that I have Extra Help. Is this a mistake?

—Louisa

Dear Louisa,

No, this is most likely not a mistake. Extra Help is the federal assistance program that helps people with limited finances pay for their Medicare prescription drug costs. If you have Medicare, the health insurance program for older adults and people with disabilities, and Medicaid, the health insurance program that serves people with limited finances, you qualify for Extra Help. In this case, you do not need to apply for Extra Help, and you should get Extra Help automatically.

Keep in mind that you must have a Medicare Part D plan, also known as a Medicare prescription drug plan, in order to have Extra Help. You can get Medicare Part D through either a stand-alone Part D plan that works with Original Medicare or through a Medicare Advantage plan that offers prescription drug coverage.

Those who do not have Medicaid, do not receive Supplemental Security Income (SSI) or do not have a Medicare Savings Program (MSP) will not automatically get Extra Help. In such situations, people with limited finances can still apply for Extra Help by completing an Extra Help application. To apply for Extra Help, people can go online and visit https://secure.ssa.gov/i1020/start. They can also apply for Extra Help by calling the Social Security Administration at 800-772-1213 or by going in-person to their local Social Security office.

—Marci

 

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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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Last Modified: 09/19/2013 14:08:42
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