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 Post subject: Obama Care / Medicare B
Post Posted: Nov 4, 2013 8:21 am 
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My mother just got a notice from the state.
She is on Social Security. She got $1170 per month. The stat paid for her Medicare Part B (medical)
The notice stats... The state will no longer pay the Part B medical. They are gonna take out of her check $105 per month for it starting Oct. They took Oct and Nov out at once leaving her $900 to live off off.
She got the notice Nov 2, 2013.
I called 9 news and gave them a copy of the letter. They are gonna look into this.
I told her to apply for Medicaid (her income is low enough)

Any one else get a letter??


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:01 am 
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What does Obama care have to do with her Medicare B premium?
Why did the state pay the premium to begin with? State never paid premium for my folks or for me. Maybe it was a mistake that they paid in the past - be careful, they may want past premiums back if it was a mistake. :yikes:


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:03 am 
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Rak wrote:
What does Obama care have to do with her Medicare B premium?
Why did the state pay the premium to begin with? State never paid premium for my folks or for me. Maybe it was a mistake that they paid in the past - be careful, they may want past premiums back if it was a mistake. :yikes:


I am curious about that myself. I don't know anyone that gets Medicare premiums paid by the state. Like Rak, I would worry that they would come in and realize the mistake and expect to be reimbursed for all the months that were paid erroneously.

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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:09 am 
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All Medicaid B medical is paid thru the state who gets reimbursed by the federal government.
All states do this..
/This is why if you travel out of state and need medical they will denied the claim and then you need to appeal. My mother broke her ankle in CA this year and her medicare B denied the claim and she is making payments to that hospital.
It is a program that the state handles.
I am asking if any one else got the letter.
My mother has Secure Horizons Medicare B.
By the way she is 79 yrs old.

By the way Obama Care. The letter quotes it and it states to go to the website to apply for other benefits


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:25 am 
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I have been on Medicare for a year now and have not paid a dime to the state for Part B. The premiums have always (by my choice) been automatically deducted from my monthly SS payment.

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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:29 am 
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Yes they are deducted from your ss check. We called them and this is what they said. They want people on the Obama care program. My mother has been on it for almost 20 yrs.

I am asking if anyone got a letter also?????
I am not here for a debate. I am looking for information.


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:32 am 
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I thought you were talking about Medicare, not Medicaid.
But Medicare Part B, you are right but you have to meet salary requirements to get the reimbursement. Not everybody gets that.

I am glad you brought this up though because I need to reach out to my best friend's parents that more than likely do get the help with payment of premiums as their income is very limited and see if they got the letter and how it is similar or the different than your Moms. If I don't call them, they won't ask for help. They live in Co Springs. I will let you know if they got anything similar, especially if I find out what steps to take to get it fixed.

By the way, what was the denial reason for not covering her out of state charges? I do know that a lot of the time medical bills are denied when a member is out of state is that the facility/doctor bills with the wrong Medicare/Medicaid agency. Even though she travelled to California, the hospital/doctor still should have billed the federal agency that handles HER medical. The appeal process is usually pretty simple, but you probably know that as there is usually instructions on the Explanation of Benefits or Denial Letter.

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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:34 am 
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When you are in Medicare and your income is below a certain, you can apply for help paying the Medicare Part B premium (and Part D premium)

Medicare Savings Programs

Quote:
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions listed under "How to Apply."


If you read this carefully, it's up to the State to decide how much money they have to allocate to helping with Part B premiums.

If you have regular Medicare (Part A, Part B, and Part D), you can go anywhere in the US and see any doctor. There is no restriction. Also, you can get a Medicare Supplemental that, depending on the plan, will pay the 20% co-pay for Part B and other possible costs under regular Medicare.

If you are in a Medicare Advantage Plan, you will probably be limited to the doctors and medical facilities in that plan. Perhaps your Mother was in one of these plans.

Obamacare does not change regular Medicare - but it does change the Medicare Advantage plans by reducing the reimbursement rate the issuing company gets for services. Where did everyone think the 200 billion dollar reduction in Medicare was going to come from? From what I read, the Advantage plans are more expensive next year and the participating doctors are reduced.


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:38 am 
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I was told to remember one thing if you apply for Medicaid: They will expect to get some of their money back in what is called Asset Recovery. I got a bill for over $100,000 "medical reimbursement" after Mom passed away, included with a letter stating I had ten days to turn everything including the house over to them or they would file for it in court. Luckily we had bought the house together years earlier so they couldn't take it, and she had little "estate". Never heard from them again.

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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:39 am 
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she did appeal this claim. While in CA they said yes they can bill the Part B. It was 2 months later she got an explanation from Medicare Part B that is was denied because it was out of service range / pcp. She did appeal. was denied.
Please let me know what you find out.
She is going into Jefferson County to apply for Medicaid. I hope she gets some where. She has a lot of meds she takes dailey,

I think she might be on that program. I will get with her to find another plan maybe.
thanks for the info Tiller Bee


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:40 am 
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ILoveHiking wrote:
By the way, what was the denial reason for not covering her out of state charges? I do know that a lot of the time medical bills are denied when a member is out of state is that the facility/doctor bills with the wrong Medicare/Medicaid agency. Even though she travelled to California, the hospital/doctor still should have billed the federal agency that handles HER medical. The appeal process is usually pretty simple, but you probably know that as there is usually instructions on the Explanation of Benefits or Denial Letter.


That is the pertinent question. Did the facility take Medicare? Not all do, you know. Was the doctor on assignment or not? That changes how much you owe. All medicare claims go to the same place, the medical facilities do not send them to the state but to the Federal Medicare.

I have alot of experience with Medicare and out of state stuff. My husband has been treated at the Mayo Clinic in MN and in AZ for years. There has never been a problem with proper (i.e. covered) expenses being paid properly.

BTW, the Mayo Clinic in AZ no longer takes Medicare patients.


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 Post subject: Re: Obama Care / Medicare B
Post Posted: Nov 4, 2013 9:47 am 
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sealy wrote:
she did appeal this claim. While in CA they said yes they can bill the Part B. It was 2 months later she got an explanation from Medicare Part B that is was denied because it was out of service range / pcp. She did appeal. was denied.


This would definitely indicate your Mother is in a Medicare Advantage plan. She does not have Part B but Part C - Medicare Advantage. Her plan probably did not cover out of state or out of network reimbursements. The medical facility did take Part B but not her Part C, Advantage Plan. When a person is in a Part C - Medicare Advantage Plan, Parts A, B, and D no longer apply.

You need to find what her plan is and, if it's not sufficient, see if you can change it now during the open enrollement, Oct. 15 to Dec. 7. I don't have any info for you about changing Advantage Plans - she might be subject to preconditions or some other restriction.

Medicare is very difficult to understand.


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