A Trump administration Medicare rule will push some hospital patients into a Catch-22: The government says several hundred procedures no longer need to be done in a hospital, but it did not approve them to be performed elsewhere. So patients will still need to use a hospital while not officially admitted — and may be charged more out-of-pocket for the care.
Under pressure from organizations representing doctors, nurses, hospitals and other care providers, a handful of states are offering them protections from civil lawsuits over medical treatment.
Hundreds of thousands of people will be able to appeal hospitals’ decisions to classify them as “observation care” patients instead of inpatients, under a ruling last week in a class action suit.
Members of Congress and others complain Medicare’s revamped Plan Finder had problems. Federal officials say they can help consumers who got bad information change their plans next year. But details about how switching will work are yet to come.
El viejo buscador de planes proporcionaba grandes ahorros, según expertos. Pero luego de un rediseño, perdió muchas de sus funciones clave.
For more than a decade, customers used the online plan finder to compare dozens of policies. Yet after a redesign of the website, the search results no longer list which plan offers a customer the best value. Federal officials say it will be fixed before enrollment begins next week.
Medicare beneficiaries under observation care in the hospital can face higher costs for treatment and are not covered for nursing home care when discharged. A federal trial in Hartford, Conn., will determine whether the government’s ban on appeals involving observation care coverage is fair.
The problem affects private drug policies and Medicare Advantage plans that provide both medical and drug coverage and substitute for traditional government-run Medicare. It could leave plan members without coverage.
El problema abarca a la cobertura de medicamentos recetados (Medicare parte D) y a los beneficiarios que tienen planes médicos de Medicare Advantage.
Federal officials are hailing the introduction of services such as transportation to medical appointments, home-delivered meals and installation of wheelchair ramps as a way to keep beneficiaries healthy and avoid costly hospitalizations. But not many plans are offering the services in 2019.
Congress approved two bills last month that prohibit provisions keeping pharmacists from telling patients when they can save money by paying the cash price instead of the price negotiated by their insurance plan.
Federal officials are allowing the private insurance plans to use “step therapy” for drugs administered by doctors. In step therapy, patients must first use cheaper drugs to see if they work before receiving more expensive options.
Beneficiarios de Medicare pueden conseguir medicamentos más baratos si pagan en efectivo… pero por reglas mordaza el farmacéutico no puede decirlo.
Sometimes a drug plan’s copayment is higher than the cash price, and under a little-known federal rule, pharmacists have to tell Medicare beneficiaries that — but only if they ask.
Under new federal rules unveiled this week, these privately run alternatives to traditional Medicare might provide air conditioners, rides to medical appointments and home-delivered meals.
Los Centros para Servicios de Medicare y Medicaid ampliaron la forma en que definen los beneficios “relacionados directamente con la salud”, que las aseguradoras pueden incluir en sus pólizas.
Last month’s budget deal means Medicare beneficiaries are eligible for physical and occupational therapy indefinitely. Plus, prescription drug costs will fall for more seniors.
Agencies sometimes turn away Medicare beneficiaries with chronic health problems by incorrectly claiming Medicare won’t pay for their services, say patient advocates.
Most beneficiaries have from Oct. 15 to Dec. 7 to decide on drug coverage and whether to switch from traditional Medicare to a Medicare Advantage plan.
Sept. 30 marks the end of Medicare’s temporary offer to waive penalties for certain late Medicare enrollees with Affordable Care Act insurance coverage.