Council on Aging Answers 2015 - 91

COUNCIL ON AGING - ORANGE COUNTY

Blue Shield of California still offers a

monthly
plan
premium

for Blue Shield 65 Plus Choice Plan (HMO),
a Medicare Advantage plan that
meets your needs from a company
that is for care, not profit.

PLUS:
* NEW! Hoag Medical Group doctors and hospitals
now in our provider network!
* $0 plan premium and $0 deductible
* $0 copay for primary care physician and specialist
office visits
* $0 copay for inpatient hospital services
* Dental coverage and non-emergency transportation
to medical appointments

Call for your free in-home Blue Shield
Medicare Advantage plan benefits evaluation.
(888) 510-8306 [TTY: 711] 8 a.m. to 8 p.m.,
7 days a week, findblueshieldcamedicare.com
Hablamos español

Blue Shield of California is an HMO plan with a Medicare contract. Enrollment in Blue Shield of California
depends on contract renewal. You must continue to pay your Medicare Part B premium. The benefit
information provided is a brief summary, not a complete description of benefits. For more information,
contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy
network, provider network, premium and/or copayments/coinsurance may change on January 1 of
each year. Other providers are available in our network. Blue Shield 65 Plus (HMO) and Blue Shield 65 Plus
Choice Plan (HMO) may be available in your area. Blue Shield of California is an independent member
H0504_14_247 CMS Accepted 08312014
of the Blue Shield Association.

Hospital Admission Or Observation - Ask!
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To qualify for Medicare coverage in a skilled nursing
facility you must have a qualifying hospital stay. A qualifying
hospital stay means you've been an inpatient of the hospital
for at least three consecutive days within the past 30 days;
beginning with the day you were admitted as an inpatient, but
not counting the day of your discharge.
Your "hospital status" -- whether the hospital considers
you an "inpatient" or "outpatient" -- affects how much you
pay for hospital services, such as X-rays, drugs, and lab
tests. Your hospital status may also affect whether Medicare
will cover care you get in a skilled nursing facility (SNF).
Even if you stay in the hospital overnight, you might still be
considered an "outpatient." You're an "inpatient" starting the
day you're formally admitted to the hospital with a doctor's
order. The day you are discharged does not count in the 3 day
requirement.
You're an "outpatient" if you're getting emergency
department services, observation service, outpatient surgery,
lab tests or X-rays, and the doctor hasn't written an order to
admit you to the hospital as an inpatient.
n According to the Medicare Rights Center, to date
there is no federal requirement for hospitals to notify
Council On Aging-Orange County | 714-479-0107 | www.coaoc.org

beneficiaries of their observation status. Ask the hospital
admitting staff for an Advanced Beneficiary Notice
(ABN) to verify whether or not you were admitted to the
hospital.
n Medicare will only cover care you get in a skilled nursing
facility if you first have a "qualifying hospital stay."
n Medicare Advantage plans do not require a qualifying
hospital (three day) stay.
n Your doctor may order "observation services" to help
decide whether you need to be admitted to the hospital
as an inpatient or can be discharged. During this time,
you're considered an outpatient. This means you can't
count this time towards the three-day inpatient hospital
stay needed for Medicare to cover your SNF stay.
If you don't have a three-day inpatient hospital stay and you
need care after your discharge from the hospital, ask if you can
get care in another setting (i.e. home health care). You can
also ask about other programs (Medi-Cal or Veterans' benefits)
that may cover your SNF care. Always ask your doctor or
hospital staff if Medicare will cover your SNF stay!
For more information, contact Medicare at 1-800-Medicare
(1-800-633-4227) or contact the Council on Aging- Orange
County HICAP (Health Insurance and Advocacy Program at
800-434-0222.
Answers Guide 2015

INSURANCE

n Linda walton RN, MS

http://www.findblueshieldcamedicare.com http://www.findblueshieldcamedicare.com http://www.coaoc.org

Council on Aging Answers 2015

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