Does Medicare Work Anywhere?

Does Medicare work anywhere I live or go? If I travel to another state, will my Medicare coverage still pay my bills? Can I see any doctor and Medicare will still pay?

Will Medicare work wherever you are? Will it be there for you when you need it most?married couple hospital bed

  • Never any networks, you can travel anywhere in the US and still have coverage
  • Medicare works with any hospital, doctor or lab in the United States
  • Medicare follows you when you move to a new city or state

Because Medicare supplement plans go hand in hand with original Medicare, you will never have a gap in coverage when you travel or relocate to a different city.

Paying too much for your Medigap plan? Use our online instant Medigap quote engine to find the best rates based on your age, gender and zip.

shop and compare GA Medigap quotes

There is nothing like original Medicare for peace of mind, especially when you move. Medicare can work anywhere.

What follows is a true story. Events actually happened. Only the names have been changed.

 

Does Medicare work anywhere in the US?

Fred and Ethel had been married for years. Like most couples, they had their spats but they always made up and deep down inside they truly loved each other.

Fred had a heart condition that required him to see a specialist several times a year. Ethyl was a nurse for many years before retiring due to health issues and she took good care of Fred. As they aged they realized they wanted to be closer to their daughter Lucy in Atlanta, so they made plans to sell their house and relocate.

Lucy loved her parents and so did her husband Ricky. Their children were grown and they agreed to invite Fred and Ethyl to move in with them.

And so it began.

 

Fred had a heart attack

Fred and Ethyl sold their home in Louisiana and moved to Georgia to live with Lucy and Ricky. The move went smoothly but not without incident.

Soon after moving Fred had a heart attack and was taken by ambulance to Northside Hospital. After being stabilized in the ER Fred was admitted to the coronary care unit where he could be monitored 24 hours. A few days later he was moved to a private room so his care could be continued until he was well enough to be discharged.

Will Medicare work anywhere?

Medicare covers emergency room, hospital ICU, doctors, scans, and inpatient lab work in full subject to a $1288 deductible (2016). For the next 60 days following admission Medicare will pay 100% of your medical bills.

Fred was ready for discharge but the doctors wanted him to spend a few days in a rehab facility before going home where he would need periodic home health care.

Medicare works anywhere. In the hospital, in rehab, at home.

 

But Fred and Ethyl didn’t have Medicare

Medicare can work anywhere, but Medicare Advantage is a different animal.

In order to save money they enrolled in a $0 premium Medicare Advantage HMO plan. What they saved in premiums they paid out in health care expenses between doctor trips and hospital visits while living in Louisiana. As Fred’s health declined their out of pocket costs grew to several thousand dollars each year.

married couple walking from storeMedicare HMO plans offer coverage for in network care and emergency care out of network. But you have no coverage for out of network treatment when it is not a medical emergency.

Lucy was helping her parents with the move so she called their insurance carrier to find out what needed to be done to continue coverage. She was told their current plan would be good for 60 days. Once they relocate to Georgia they will need to notify Social Security of their new address and secure new coverage.

But things didn’t go as smoothly as expected.

Fred’s emergency admission to the hospital was covered by his HMO even though the hospital was not in his network. But doctor visits by both Fred and Ethyl prior to his admission were not covered and they had to pay out of pocket.

Fred’s rehab and home health care would not be covered by his plan either since Atlanta providers were not included in his plan.

Their out of pocket expenses had already run more than $1,000 and they were going to become even higher unless they could secure new coverage.

Lucy called me three days before the end of the month, asking for my help in securing new Medicare coverage. Specifically, she wanted a Medicare supplement plan for her parents.

 

What she wanted was impossible

When Lucy called, her dad was still in the hospital and they had not yet notified Social Security of the change in address. The best we could hope for would be to have everything in place by the first of the month following.

In the meantime their non-covered medical expenses were mounting.

Even moving to another Medicare Advantage plan with Georgia networks is possible, but not within the time frame they needed.

Original Medicare has no networks. If Fred and Ethyl had original Medicare and a supplement plan their out of pocket exposure would have been minimal.

Their Medigap plan would also follow them from Louisiana to Georgia without a hitch. No need to change plans. The same coverage they had in Louisiana would continue in Georgia.

Does Medicare work anywhere? Absolutely. So will your Medicare Advantage plan. Just be prepared to pay more when you travel out of the Advantage plan service area, and changing coverage once you arrive may be a challenge.

When you want full coverage anywhere you go, nothing beats original Medicare and a Medicare supplement plan

original medicare supplement coverage

 

Popular searches that lead to this page.

Does Medicare cover me when I travel? Am I still covered by Medicare when I travel out of state? Can I go to any provider when I have a Medicare Advantage plan? How does Medicare Advantage HMO work?

 

#Medicare #MedicareAdvantageHMO

How Much is that Doggie in the Window?

If you were around in the 50’s you couldn’t hardly turn on a radio without hearing Patti Page ask “How much is that doggie in the window?” You know, the one with the waggly tail.  doggie in the window

That was then.

This is now.

The question today is, “How much is that non-contrast brain MRI in the hospital?”.

WSBTV Channel 2 wanted to know, so they asked.

A call to 10 local hospitals gave some interesting results.

Some hospitals, such as Grady Hospital, named a price on the spot: $3,148. At other hospitals, getting an answer was a challenge.
 
When the hospitals were called a second time, half of them offered a different price for the same procedure.
 
At Piedmont Healthcare, the list price went from $4,180.51 to $7,079.76.

As they say on TV, but wait, there’s more!

One day, WellStar Health System said its list price for a non-contrast brain MRI was $969.10. Later in the day, WellStar offered a different quote: $12,879.71. 

When confronted about it, a WellStar representative said, “An error had been made in providing you the second price.”

I suppose it depends on what time of day you call.

The average price at hospitals for the brain MRI was more than $3,000, compared with a call to an outpatient center called OMI diagnostics: $475.

For what it’s worth, outpatient procedures are almost always less expensive at a free standing clinic vs. done in a hospital.

According to the Health Care Bluebook a non-contrast brain MRI in Atlanta should run about $563.

Consumers without health insurance have to be good shoppers but the same is true for seniors on Medicare. Even though Medicare determines the amount they will pay for things like an MRI, what YOU  pay can vary greatly depending on the type of coverage you have.

If you simply have traditional Medicare your share could be less than $300 if you had not yet satisfied your Medicare Part B deductible.

Seniors with Medicare and supplemental plan F Medicare insurance would have $0 out of pocket. Under a Medicare Advantage plan your cost could be anywhere from $100 to several hundred.

That is a significant difference and this is for a relatively minor procedure.

Georgia Medicare Plans works closely with our clients to help them understand the benefits and pitfalls of Medicare Advantage vs supplemental Medicare insurance. Once they understand the difference, almost everyone of them buy a Medicare supplement plan.

We not only educate you on the differences in Advantage vs. Medigap, but you learn which plans have the most value. We recently showed one couple in south Georgia how to save over $1700 per year by switching from their Mutual of Omaha plan F.

How much can you save? Shop and compare with in instant quote.

Medicare Hospital Bonus

Do you know about the Medicare hospital bonus program? Hospitals can get cash for better results. The idea sounds good in theory, but there is a dangerous underbelly to this plan.

Medicare last month announced bonuses and penalties for nearly 3,000 U.S. hospitals as it links almost $1 billion in payments to the quality of care given to patients.

It’s part of a move by government and private insurers toward rewarding medical providers based on their quality of care, not the quantity of services.

Georgia Health News

Quality of care bonuses. What could possibly go wrong?

So how does Medicare decide winners and losers?

Eight of the current 25 quality standards, Yahoo News reported, are based on patient satisfaction: communication with nurses; communication with doctors; responsiveness of hospital staff; pain management; communication about medicines; cleanliness and quietness of hospital environment; discharge information and overall rating of the hospital.

The rest are based on  how often hospitals followed clinical standards of care, such as controlling heart surgery patients’  blood sugar levels and giving them beta blockers to lower their blood pressure.

All sounds so simple. If a hospital delivers better results, and you are a satisfied customer, they can get a Medicare hospital bonus.

Do you think hospitals might “cherry pick” the Medicare patients they take in and the type of services they will provide to Medicare patients? And does it matter if you have a Medicare Advantage plan or original Medicare and a Medicare supplement plan (where you can choose your doctor and hospital)?

The maximum amount any hospital could gain or lose was 1 percent of its regular Medicare payments.

For nearly two-thirds of the hospitals, the changes are less than a quarter of a percent, KHN said. Still, for hospitals with a high number of Medicare patients, hundreds of thousands of dollars are at stake.

The caps will rise to 2 percent over the next four years.

The maximum Medicare hospital bonus (or penalty) now is 1%, rising to 2%. But will it stop there or keep climbing?

If a hospital can game the system in hopes of qualifying for the maximum bonus, how many really sick patients with expected poor outcomes do they have to reject in order to earn the highest kickback from Medicare?

This is about more than money. It is about your health and quality of care. Georgia Medicare Plans is concerned about your health and the health of your wallet. Save money by comparing your existing Medigap rates with an instant GA Medigap quote.

Medicare Patients Face Bigger Hospital Bills

Medicare patientsMany Medicare patients may find themselves paying more for their care following a hospital stay. A LOT more. If your hospital admission qualifies under Medicare rules, you are entitled to up to 20 days convalescent care that is covered by Medicare.

But some Medicare patients are short changed due to the way their hospital stay is coded. They can still go to a nursing home, but may have to pay hundreds or thousands of dollars up front.

A patient could be treated at a hospital for congestive heart failure for four days then, because the stay didn’t count as an admission, owe $250 a day for follow-up nursing home care.

Post Gazette

Ouch!

Medicare patients need to know the rules if they want to hang on to their money. The federal government is trying to balance their budget on the backs of seniors.

What has changed is Medicare’s interpretation of what constitutes an inpatient hospitalization — and several days in a hospital bed receiving treatment under a doctor’s care does not necessarily meet the criteria.

Medicare changed the rules, but did you get the memo?

No, because there wasn’t one. In most cases you discover the rule change when you get a huge bill from the nursing home.hospital

Historically, an outpatient observation would be a period of time when a person is being evaluated for something like chest pain or is receiving short-term treatment while doctors decide if further, inpatient care is needed.

But, in an attempt to hold down costs, the scope of “observations” now can include spine fractures or overnight stays that last several days while the patient undergoes tests and receives treatment.

The definition of observation changed. If your stay was less than 24 hours it would have been classified as observation, not an inpatient admission. But now you can stay several days without technically being admitted.

With Medicaid, which provides coverage for low-income families, observations are not reimbursed at all.

Now Medicare patients and those with private insurance are paying the price, too. Under Medicare rules, a beneficiary is entitled to a nursing home stay following a minimum three-day hospitalization. But it must be a three-day admission — and neither time spent in the emergency room nor the day of discharge count.

In other words, someone can be receiving hospital treatment for congestive heart failure over four days but Medicare may consider it an observation. Then, when the patient transfers to a nursing home afterward, there’s no coverage — and the facility may start charging $250 a day or more.

So now you know.

If you are a Medicare patient in a hospital, know the rules unless you want to pay dearly.

If Medicare denies your claim, your Medicare supplement plan won’t pay either. Something to keep in mind.

Georgia Medicare Plans have the best Medigap rates in Georgia. Check us out for yourself.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

#Medicare  #observation

Compare Georgia Hospitals

How good are hospitals in Georgia? Is your heart attack treatment better at one hospital and cancer outcomes better at another? Are chances of survival better at some hospitals?

Medicare has a hospital compare tool that allows you compare how well hospitals care for patients with certain medical conditions or surgical procedures. Using surveys by patients and other data you can be in charge of your own care.

Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients.

Detailed information on over 4,700 hospitals across the nation is provided. You can find all the ones near you for comparison by entering your zip code or city name. Choose up to three hospitals to compare at once against quality measures such as how soon surgery patients received antibiotics, hospital mortality rates (rates of patients dying within 30 days of being admitted to the hospital, compared to the national average), and patient satisfaction survey results. All of this data helps you see how well patients are treated and whether the hospitals follow recommended health care procedures.

Medicare Hospital Compare

For several years, Medicare Hospital Compare initiative has published quality measures for hospitals. While the Medicare Hospital Compare data is intended to help patients make better decisions, some experts have noted that the public nature of the information might also help spur lower-performing hospitals to shape up, improving the quality of care.

But the project hasn’t led to improvement in 30-day death rates from heart attacks or pneumonia, and is linked to only a small reduction in death from heart failure, according to a new study.

The research, published yesterday in Health Affairs, analyzed Medicare claims data from 2000 to 2008 to come up with mortality trends. And it concludes that with heart attacks and pneumonia, death rates were already improving for other reasons and weren’t improved further by the program.

A modest improvement in the mortality rate for heart failure might be due to the program, but it might be unrelated, the researchers write. More research is needed on that point, they say.

Hospital Compare began in 2005 by publishing so-called process measures for individual hospitals, which look at factors like what percentage of heart-attack patients got aspirin when discharged from the hospital.

“This isn’t a total indictment of public reporting … or of Hospital Compare,” says Andrew Ryan, an author of the study and assistant professor of public health at Weill Cornell Medical College. But the way the program was structured during the time period it was studied doesn’t appear to have significantly reduced the number of patient deaths, at least for these conditions.

In 2008 Hospital Compare began to publish mortality and hospital readmissions rates for heart attack, heart failure and pneumonia, and has also added other measures, such as patient satisfaction, over the years.

“The Hospital Compare program has been evolving, and that could [produce] a change in how patients respond or how providers respond,” says Ryan.

So far the tool has gotten more attention from the hospitals themselves than from patients; this study and others suggest that neither doctors nor patients are paying much attention to Hospital Compare when they pick a hospital.

http://blogs.wsj.com/health/2012/03/06/medicares-hospital-compare-program-hasnt-helped-save-lives/tab/print/

Hospital Patient Checklist

As anyone who has been a patient or a visitor at a hospital knows, they’re often confusing, chaotic places. By the time you learn the routines and the rules of the hospital, with any luck you’re recovered and on your way out the door.

Elizabeth Bailey’s father wasn’t that fortunate. When he started experiencing double vision several years ago at age 81, he had a biopsy performed on an outpatient basis at a New York hospital to determine if he had a rare and dangerous inflammation of an artery near his temple. He didn’t, as it turned out. But things went downhill from there.

He had been prescribed a high dose of the steroid prednisone before the biopsy to prevent inflammation, and his post-op instructions said to continue all pre-op medications following surgery. Unaware that this referred only to drugs he had been taking on a regular basis (exluding the ones immediately before his hospital stay), he kept taking the powerful steroid and even refilled his prescription.

A few days later after discharge from the hospital, he wound up in the hospital  emergency room with steroid-induced psychosis. Not only that, but his previously mild Type 2 diabetes had worsened significantly and his blood sugar had increased to dangerously high levels. Doctors said it was probably the rising blood sugar levels that had caused his double vision in the first place.

Bailey and her two sisters took turns at their dad’s hospital bedside during the month he was in the hospital. Almost immediately, things started to go wrong when they weren’t around: He was given standard hospital meal trays instead of the sugar- and salt-free food his doctors had prescribed; the sisters discovered pills he should have taken on the floor and in his bedclothes; after an MRI scan, he was left for hours sitting in a wheelchair in a hospital hallway, waiting for someone to pilot him back to his room. One morning, he put some clothes over his hospital gown, went down to the lobby and hailed a cab to take him home. No one at the hospital noticed until midafternoon, when Bailey arrived and raised the alarm.

“I think the biggest mistake patients [and caregivers] make is that they think the hospital will take care of everything,” says Bailey, a former music video producer who is completing a master’s degree in health advocacy and plans to work with hospital patients. “It’s that psychology of being the passive hospital patient that can be such a problem.”

After so many missteps, another person might have quietly taken note never to use that hospital again — or filed a lawsuit. Bailey instead developed “The Patient’s Checklist,” a book of 10 checklists that address many of the essentials for a hospital stay, including sections on what to bring with you, medication management, how to make your hospital stay safer and more comfortable, and planning for your discharge.

The idea came from Bailey’s work in film production, where she always kept lists spelling out details about crews, shots, equipment and the like. The hospital “reminded me of a really badly run film set, and I just thought, ‘I need to produce this,’ ” she says.

“Checklist” has become something of a buzzword in health care in recent years. Many hospitals have embraced the idea for their staffs, aiming to improve patient safety and quality of care by ensuring that basic but critical steps are taken every time certain activities or tasks are performed. Checklists may cover everything from how to change the sheets on a bed to steps to reduce surgical complications. In a seminal studypublished in the New England Journal of Medicine in 2006, roughly 100 Michigan hospitals that adopted a simple five-step checklist for inserting central-line catheters in intensive-care patients reduced bloodstream infection rates by up to 66 percent over an 18-month period.

The checklist included seemingly no-brainer steps such as requiring staff members to wash their hands and wear sterile gowns and gloves. But that’s part of the point: Many procedures are routine, caregivers are busy and small omissions can have disproportionately bad results.

“There’s a lot that’s art in medicine,” says Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins School of Medicine, who was the lead author on the NEJM study. “But some things we’ve figured out. Patients are always going to be worried, but checklists allow them to worry about the things that really matter.”

According to a watershed report published by the Institute of Medicine in 1999, medication errors in a hospital accounts for up to 98,000 deaths every year. Some experts suggest the number is probably higher.

The checklists in Bailey’s book include templates for patients or relatives on managing hospital medications, including a master medication list that describes every drug being taken, the frequency, dosage, prescribing doctor’s name, special instructions and more, as well as a daily medication log where patients can keep track of every pill, injection and IV drip they’re given each day.

Another list covers details such as getting to know the names of every nurse and aide, regularly wiping down surfaces such as call buttons and the TV remote with antibacterial wipes, and staying warm and hydrated to promote faster healing.

Of course, being an assertive patient may not make you popular with overworked hospital staff. “Oftentimes, my tribe – the physicians or nurses — aren’t very welcoming of questions,” says Pronovost.

In such cases, Bailey says, a little diplomacy goes a long way. “I start from the place of ‘We all have a common goal, which is the best possible outcome for this patient,’ ” she says. ” ‘We’re on the same team, and I need to understand my care.’ That’s very legitimate.”

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/Patient-Checklists-Michelle-Andrews-03052012.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn+%28All+Kaiser+Health+News%29