Ms. Z was a patient at a skilled nursing facility (SNF) for 100 days to treat a broken hip. She was discharged from the SNF after 100 days because she had run out of days in her benefit period. However, 20 days later she broke the other hip and was admitted to the hospital. She wants to know if Medicare would cover the SNF care she would need after she was discharged from the hospital.
Mr. F has Original Medicare Parts A and B. He was in a Department of Veterans Affairs (VA) hospital. After three weeks in the hospital, he wanted to transfer to a Medicare-participating hospital closer to his home. Since VA facilities do not participate in Medicare, Mr. F did not know if the transfer would create any coverage problems.
Ms. B was receiving Supplemental Security Income (SSI) and had Medicaid when she became eligible for Medicare. A Medicare representative told her that Medicaid would automatically enroll her into a Medicare Savings Program (MSP) and that the program would pay her Part B premiums. However, six months later, she received a letter from Social Security informing her that her Part B benefits had been terminated because of non-payment of her premiums.
Ms. L is 92 years old and has Original Medicare. She needed help paying for her Medicare Part B and applied for a Medicare Savings Program (MSP). A few months later she received a letter saying she qualified for the Qualified Individual (QI) program, which pays the Part B monthly premium but, a year later, the Part B premium was still being deducted from her monthly Social Security check.
Mrs. M spent six weeks recovering in a skilled nursing facility (SNF) after being in the hospital for a broken collarbone. Medicare covered the first month of her stay in the SNF, but not the last two weeks because it believed the care was no longer medically necessary. Mrs. M received bills for almost $5,000 from the SNF for the last two weeks of care.
Mrs. P is going to have an operation soon and will need to be in the hospital for about two weeks. She is concerned that she will have to pay a lot for the hospital stay under Original Medicare. She does not have supplemental insurance.
Mr. T has a disability. He enrolled in Part A 20 years ago, but declined Part B because his wife was working for a company that provided him with health insurance coverage. Soon after his wife retired, Mr. T went to his local Social Security office to sign up for Part B. A representative at Social Security told him that its records showed a five-year gap in his employer group health coverage. Mr. T was told that he would have to pay a premium penalty for the five years and wait to enroll into Part B. Mr. T did not believe this was accurate, since he was covered by his wife’s employer insurance continuously.
Mr. H has a disability and had Medicare Part A. He had health care coverage through his wife’s employer insurance, so he did not enroll in Part B. In November of 2011, Mrs. H stopped working, but kept her employer coverage. Mrs. H did not return to work, so her employer coverage ended in May 2012. Mr. H applied for Part B coverage in August of 2012, but his application was denied. Social Security said that Mr. H was outside his eight-month Special Enrollment Period because his wife ended her active employment in November 2011. Mr. H would have to wait for the 2013 General Enrollment Period, and his coverage would not begin until July 2013.
Mr. C had been receiving Social Security Disability Insurance (SSDI) for 24 months and became eligible for Medicare in December 2012. Mr. C enrolled in Part A but turned down Part B because he felt he could not afford the Part B premium. Soon afterwards, Mr. C realized that without Part B he would not have coverage for his doctor’s visits. He went to his local Social Security office to enroll in Part B in early January 2013. However, when Mr. C received his Medicare card, it stated that his Part B coverage would not begin until July 1, 2013.
Mr. D recently returned home after being hospitalized with a number of severe medical conditions, including end-stage renal disease. Mr. D requires dialysis three times a week. His family contacted a local ambulance company to request regular appointments for transportation to the dialysis facility, because he is confined to his bed. The family also forwarded a letter from Mr. D’s doctor stating that this transportation was medically necessary because Mr. D needs medical services during your trip that are only available in an ambulance. However, the ambulance company refused to transport Mr. D because it said that Medicare would not pay.