Toni Says

by Toni King


Didn’t Enroll in Medicare Part D… Now We Owe Big Dollars!!

Toni:
              My husband, Joe went in the hospital from the ER for 2 days and because it was considered “under observation”, we are now fighting the hospital because they say his drugs were not covered during his stay.
 
             He does not have a Part D plan because he did not take any prescriptions when he turned 65 What should we do?  Thanks, Cynthia from Tomball area

Cynthia:
            hospital stay falls in “under observation” he might have to pay for the drugs administered because his stay is under Part B which does not cover prescriptions given orally. 
            Part B (Medical Insurance) covers IV (intravenous infusion) drugs and since your husband was considered outpatient care he was not an inpatient care, which would have qualified for a Medicare Part A- inpatient hospital stay with drugs covered.

            Medicare Part B generally covers care that you receive in a hospital outpatient setting like an emergency room, observation unit, and outpatient surgery center or pain.

            This is why enrolling in a Part D Medicare drug plan is so important because when you are admitted in a hospital on an outpatient basis you may need your self-administered drugs.  Self-administered drugs are what you would normally take on your own or over the counter type drugs. Part B does not pay for these types of drugs, but a Medicare Part D Prescription Drug plan can.

            If you do not have a Part D drug plan while in a Part B “under observation”, hospital outpatient setting or emergency room, then you may pay for the drug cost out of your pocket as you and your husband are experiencing.

            During a Toni Says® Medicare consultation, everyone is advised on the importance of enrolling in a Medicare Part D plan when first enrolling in Medicare.

            The new American Baby Boomer Society website has course #6 which explains Medicare Part D and the famous donut hole.  Visit www.abbs4u.com website to join.

            To keep Joe from paying for prescriptions out of pocket whether in or out of the hospital, I would advise you to see if he qualifies for Part D “Extra Help” from Social Security or Medicaid. If he qualifies then he can enroll in a Part D plan now or he will have to wait until Medicare’s open enrollment which takes place in October 2018 and enroll in a Medicare Part D plan because he has missed his “initial enrollment period”.
         
            Below is what to do when one receives a hospital bill for prescriptions not covered by Part B in a hospital ER or outpatient setting:

  • Most hospital pharmacies do not participate in Medicare Part D; you may need to pay up front and submit the claim to your Medicare Part D drug plan for a refund.
  • Follow instructions on how to submit an out-of-network claim.
  • You may need to forward certain information like emergency room bills that show what self-administered drugs you were given.
  • Keep copies of receipts and paper work you send to your Part D plan.

Toni King, author of the new Medicare Survival Guide® offers a Toni Says® Medicare column readers discount available at www.tonisays.com. Email Medicare/long term care questions to info@tonisays.com or call 832/519-TONI (8664).