Many seniors want to know if they can stay in the hospital without paying a Medicare Part A deductible. In fact, hospitals and inpatient facilities cannot refuse to provide treatment.
Even if you’re not current with your Medicare Part A deductible payments, hospitals must provide you with proper treatment. Medicare Part A is the portion of Medicare that provides coverage for hospital and inpatient services for enrollees.
Beneficiaries needing emergency care services will have access to them, whether they’re able to pay for them or not. This rule is protected by The Emergency Medical Treatment & Labor Act.
However, hospitals must follow strict guidelines about how and when to collect a Medicare copayment or deductible from beneficiaries. The Centers for Medicare and Medicaid Services (CMS) created these strict guidelines for hospitals to regulate the billing aspect of inpatient services for beneficiaries.
Staying in the Hospital Without Paying a Medicare Deductible
Hospitals may not deny treatment to Medicare beneficiaries who still have inpatient hospital benefits. Additionally, hospitals cannot demand that you pay your Part A deductible or make a co-payment before they provide treatment.
If Part A benefits run out while receiving inpatient services, the hospital might apply a prepayment policy. A similar policy is used for patients that don’t have health insurance coverage.
Policies of this nature will vary depending on the hospital. Similarly, hospital policies may require you to make a prepayment for certain services that Medicare plans don’t cover.
Depending on the hospital’s policy, prepayment for services like comfort items and private duty nursing may be a requirement because Medicare doesn’t cover these things.
Talk to the hospital’s billing department about coverage for inpatient services. The billing specialist can tell you what your plan isn’t covering throughout the duration of your hospital stay.
The hospital can deny extra services to you once your Part A benefits run out. If you fail to make the prepayment, the hospital can then deny your request for extra services. Denying these services can last for the remainder of your inpatient hospital stay.
For individuals who don’t have any health insurance coverage may need to make a prepayment before receiving treatment. Some hospitals request a deposit or proof that you’re able to pay for any and all services.
Prepayment Before Admission
The CMS has strict rules and guidelines for hospitals and inpatient facilities to follow. Including, hospitals cannot ask for prepayment of any Medicare deductible or copayment as a prerequisite for treatment. Although, hospitals may have policies that request prepayment from patients that have other insurance coverage, not Medicare.
Hospitals must present any prepayment request as just that, a request. This should be done “without undue pressure”. Meaning, you should never be uncomfortable receiving necessary care and treatment due to a lack of Medicare deductible payment.
Health-care facilities or hospitals that still have these requests should post a visible sign. CMS clearly states, “no person will experience refusal upon admission or medical treatment if a said person should be unable to make the advance deposit or prepay the Medicare deductible.”
Paying Deductibles Upfront
Your health insurance deductible is the amount you must pay before your insurance plan will kick in and start to help pay for your medical costs. Medicare Part B is coverage for medical services like doctors’ visits, testing, screening, and out-patient services.
Once the deductible is met, the plan covers the remaining expenses. It’s common for beneficiaries to see their doctor multiple times or receive multiple services before reaching their plan’s deductible amount.
Can a hospital force me to leave
While residing in an inpatient facility, you have legal rights to appeal should they decide to discharge you before you’re ready. If you’re uncomfortable with your discharge date, request a fast-track appeal provided by the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
Within 2 days of your admission, the hospital or inpatient facility must give you a notice to as an IM (Important Message). The IM is to inform you about your rights under Medicare. The IM is a notice containing contact information for the BFCC-QIO and directions on how to request a fast appeal.
If you follow the instructions and are within the proper appeal time-frame, the hospital/facility may not force you to leave during the appeal process.
Let’s use Susan for an example. Susan is staying at an inpatient facility, but her doctor is mentioning her discharge plan. She knows she isn’t ready to leave the hospital and go home.
Susan quickly pulls out an IM that she was given 2 days after hospital admission. This notice has contact information and directions so she can file a fast appeal. Susan follows the directions after reviewing her Medicare rights as a patient, all found on the IM.
Once Susan completes filing, the fast-appeal process begins. Once the appeal is in motion, the hospital can’t force her to leave.
Susan’s appeal went through, the BFCC-QIO determining she was right. Susan isn’t ready for discharge, so Medicare is covering the cost of expenses if it’s medically necessary.
A Hospital Stay Without Paying a Medicare Deductible
Out-of-pocket Medicare costs are simply unaffordable for some seniors. The good news? Alternative insurance options for Original Medicare coverage.
People seeking help with out-of-pocket Medicare costs (like copayments, deductibles or coinsurance) should consider joining a Supplement Insurance plan.
Supplement insurance or Medigap may cover all or part of the Medicare Parts A and B coinsurance and deductible costs. Furthermore, enrolling in a Medigap plan will give you more benefits than what Original Medicare offers.
However, before enrolling in a Supplement plan, you need to have both Part A and Part B. You cannot buy or enroll in a Medicare Supplement plan if you already have a Medicare Medical Savings Account (MSA); it must be one or the other.
Medigap requires enrollees to pay a monthly premium amount for their Supplement insurance plan in addition to the Medicare Part B premium.
Medigap or Medicare Supplement plans are by private insurance companies that work alongside Original Medicare. Not all plan types are in all areas, the service area you live in will determine your plan options. Working with an agent is the smartest and easiest way to enroll in a Medigap plan.
Get Help Paying the Medicare Hospital Deductible
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