Has the Affordable Care Act reduced coverage for elderly over a certain age?

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Has the Affordable Care Act reduced coverage for elderly over a certain age?

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It's not the ACA. Hospitals have started admitting people "for observation," which may mean that insurance doesn't pay as much of the bill. If she were an inpatient, maybe more would have been covered. There have been cases of people being held for observation and not admitted for three! whole days.

I would assume that it's a screw-up with the insurance. Please let us know how this works out.

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She was in extreme pain, doubled over. She did not know what was wrong, so it would have been hard for her to say no tests in that condition.

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If she went out of network and had no prior authorization, she may get stuck with the bill. Many insurance companies have totally dropped coverage for walk-in non-hospital clinics. You said they warned her; she didn't listen to them. Call her insurance company and try to straighten it out.

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No - the changes might be in the way they are billing, which could be an indirect result of the ACA going into effect, but it has nothing to do with the ACA per se, as that is not affecting medicare or what medicare covers. The issue may also have to do with the hospital/facility not obtaining approvals from the insurance company prior to running the expensive tests, etc. - again - it's about how they are being done, not about ACA. Don't pay the bills unless you have been told they are services not covered by her insurance or medicare, and then question why they were even done if they weren't covered.

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Well I don't know about any of this, as now my elderly mother-in-law, recently hospitalized and now in rehab, is getting very large bills from her care. She is 91 and has very good coverage and Medicare. It is daunting to think of what is going to come yet in bills! I am sure all of you are writing with past experience, but I am saying that from my position with these two elderly women, I see much more out of pocket expense for any medical care for elderly. It is down right scary!! And this appears to be new . . . charging the elderly and hitting their personal finances rather than insurance and medicare picking it up. Very sincerely, I hope I am wrong, wrong, wrong, but from what we are seeing, it appears changes have happened.

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It can take months for insurance to pay a hospital bill - a lot of times a copy of the bill from the hospital gets to the patient before insurance or medicare has paid any of the portion - it doesn't mean that is what she owes YET. Call the insurance company and ask them. My aunt made the mistake of thinking that was actually her bill for $20,000. - she pulled money out of her retirement account and paid it - turned out the above had happened, and she got a refund a few months later.

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Ever answer provided additional advice that, from my experience, is well founded. Thanks for being such a great community and responding when people need advice and/or comfort.
Carol

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The ACA has no effect on Medicare. If she has regular Medicare, most people have a supplement that will pick up the deductible and copays. Unless you are like my Dad & Step-mom who cancelled their supplements as they said they couldn't afford them. (But they eat every meal at restaurants as neither cooks... another story!). If she switched to a Medicare Advantage plan (heavily advertised on tv), that disenrolls you from traditional Medicare into their plan. If the emergency room she went to is not a participating provider for that Medicare Advantage plan, she can be billed for those services. I agree, check hospital coding but also check if which type of Medicare supplement she has. If it's a MA, find out if the hospital is a participating provider. If it is a life-or-death emergency, there may be a provision for the MA to pay even if they are not a provider.

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So she paid the $15,000? Be sure to get it submitted to her supplemental insurance. My mom kept paying bills before their secondary insurance had a chance to pay. I wound up getting over $2,000 back from a variety of doctors that she had overpaid. It took forever. Sometimes doctor's offices will hound you if the secondary insurance is slow to pay, but it's still the insurance company who should pay, not the person. And many times, the doctors agree not to bill beyond what the insurance companies (Medicare and supplemental insurance) will pay. Your explanation of benefits, or EOB from the secondary insurance should show what the patient owes if anything.

And most of the Affordable Care Act doesn't take effect until 2014. So I don't think that's what's changed, if anything has.

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thank you -- I will try and contact one of her children with what I found out she paid and with your information.

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That's not likely. If she has "good insurance" and is on Medicare, I would guess that she is on one of the supplemental plans. The cheaper plans have larger copays, the more expensive ones few to none.

All too frequently, the problem is with the coding done by the hospital, so she should should start with her insurance company and ask how to go about seeing if the hospital coding is correct.

I might add that people on Medicare often get statements from the insurance company that reflect the cost before their supplemental plan is considered. It can be horrifying. So, please have her call. She may not owe as much as she thinks.

About the fact that they didn't know if something is covered - that's scary for people. It's not the Affordable Care Act - this has been the case for years. If something isn't covered by Medicare, then it's not covered by the supplemental insurance either. And the costs - as you saw - can be incredible.I hope this isn't the case with your friend.
Warm regards,
Carol

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Has the Affordable Care Act reduced coverage for elderly over a certain age?

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