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

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An elderly friend recently had to go to emergency with severe pain and was told that any tests run may not be covered for her. When she received the bill, it was around $15,000!! She has good insurance and also Medicare, so we wonder if the Affordable Care Act has reduced coverage for people over a certain age?

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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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OK all, I did decide to make contact with my elderly friend's daughter at her work place. She was SO grateful for my call (concerning her mom's payment of about $15,000 in an overnight hospital stay with tests) and will be looking into it soon. Her mom obviously made the decision to pay the large bill without asking one of her children about it. Daughter I contacted gave me her own cell phone so I could call again when I notice anything I think the family should know. I feel so much better now! Thanks for all the help and encouragement. Now to keep things ok with my own parents!! Calling our insurance agent this morning.
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BREN34748 - I believe that that is what you were told, but I don't believe that that story is true, not in the details.

My father had cancer and an aortic aneurysm. The aneurysm needed to be fixed first, and that surgery could have killed him. My father chose no treatment, rather than risk the aneurysm.

The doctor may have decided that your neighbor was too frail for surgery. I won't believe that the reason was his age, or that that was the only reason.

I know that there are NO laws that would allow such discrimination. It's possible some arrogant doctor might have decided that, but that's the fault of one doctor, not the ACA.

It's awkward, because I won't believe it without proof, and this is an anonymous website, so you can't really give me proof. We'll have to agree to disagree.
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It has to do with Medicare trying to save money, of course. Medicare pays less for a patient who is not "admitted." They have contractors whose job it is to make sure all admissions are truly needed. Google "observation vs admit to hospital" for a Boston Globe article from 8/24/2013.

It's complicated. I don't want Medicare to make ME pay more for my care, but I want them to cut out all the fraud and abuse from "the bad guys." I want Medicare to be available to me and my daughter, and they need to reduce the costs to ensure that. Rock and a hard place.
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I just turned 65 last week and went early in the month to a dermatologist and discovered a melanoma on my arm. I am in aarp medicare advantage and find it great. this is the 1st illness I have ever had, on no meds, eat healthy, but melanoma is heridatary, did not luck out here! dermatologist was $35, hospital yesterday was $250. I had an agressive melanoma cancer so they did inject nuclear dye into it to check the sentinal lymph nodes. they operated both the removal (by a plastic surgeon) of the melanoma and another surgeon found 1 sentinal node showed the cancer and removedd that. I am blessed it only go that far. someone earlier stated that the advantage plans replace regular medicare-this is not true, it does all the paperwork, for medicare. itis still the same, medicare pays it part and my advantage supplemental(which is free) pays the rest. My mother has been on this type of plan for as long as they have existed. 2 yrs ago, (she is now 95), she discovered a large golf size lump in her breast and it was cancer. they had to remove her left breast and all she paid for everything was $1,000. she is also very healthy, and this is still cheaper than paying for one of their other supplemental plans. No One over 60 should go to a dr or hospital without another person who can help make decisions.
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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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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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Jinx4740 Do you know why the hospitals are admitting patients for observation rather than just straight in patient? I am curious, this just happened to my mother who was admitted for gall bladder stones and the need for surgery, instead they admitted her for observation for 3 days, the doctor then comes and says they are releasing her and she will have to live with the pain. This HMO doctor says that because Mom has been taking Warfarin and her history of heart arrhythmia, they do not want to take a chance on surgery!!!! She left the room to release my Mom and in 5 minutes a surgeon is standing at Mom's bedside telling her he can do the surgery tomorrow with no problem and he was right. I just don't get the "observation" thing as Mom's Gastroenterologist is who sent her to the hospital for surgery.

There are some tests and physical therapy that use to be covered by Medicare but it is no longer covered or has been reduced. When something like this happens the patient is suppose to be informed and they even have you sign a form stating that you realize Medicare may not cover whatever it is. If you sign it and they do it, you are saying that you agree to pay for said services. The thing is you keep saying she has "really good insurance and Medicare." That statement worries me as normally Medicare is the primary insurance, if you are no longer working. When I hear patients say things like this I get sick to my stomach as it normally means they belong to an HMO and have signed their Medicare benefits over to the HMO. When this happens, you no longer actually have Medicare, you now have an HMO, like Kaiser, Humana, Scan, etc. YOU MUST SEEK ALL CARE THROUGH THEM AND THEIR DOCTORS AND HOSPITALS, MUST, MUST, MUST!!!!!!! If you fail to do this you will be responsible for paying all charges because you did not seek care through a participating provider!!!!!!!!

Lastly NEVER PAY A BILL LIKE THIS!!!!!! UNTIL YOU HAVE CHECKED OUT WHY IT WAS NOT PAID AND IS IT BEING SUBMITTED TO A SECONDARY INSURANCE CARRIER!!!!! IF YOU PAY ANY AMOUNT OF MONEY TO A DOCTOR OR HOSPITAL, MANY OF THEM DO NOT REIMBURSE YOU AUTOMATICALLY....UNLESS YOU ASK THEM TO!!!!!!

This ticks me off to no end, but I have worked for them and let me tell you they will hold on to the money because they can. There is no law that states that they have to pay you back within any amount of time. I think this is wrong, wrong, wrong and they should be penalized for doing it, but when they see they have $100,000 sitting in their bank account that should be refunded, they don't want to and they will hold on to your money!!!!!!!! My former employer is currently sitting on a large sum of money that he refuses to refund of his own accord and has instructed his bookkeeping office to hold on to the funds unless the patient requests a refund. Most of these patients are elderly and do not even realize they have a refund coming. It is sickening!!! DO NOT PAY ANY PHYSICIAN OR HOSPITAL UNTIL YOU HAVE EXHAUSTED ALL AVENUES OF PAYMENT TO THEM. DO NOT GO OUTSIDE YOUR HMO EITHER!!!
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HolyCow I'll tell you what I did. When my parents moved up here to be near me, I took the booklet with the list of the doctors in their PPO to our hospital. I went to the general nursing floor and went to the nurses' station. I asked the nurses to point out which doctor(s) they'd recommend for their elderly parents. At first, one nurse didn't want to help (they're afraid they'll get in trouble), but another one came over and started looking and giving me feedback. Comments like, "I wouldn't take my dog to him"... stuff like that. I soon had two or three nurses going through my list. I found a great doctor for my mom and dad that way. You may find resistance (and do it when docs aren't there at the nurses' station doing their rounds) but it worked for me.

When my mom was to have a heart procedure, the cardiologist in the practice was arrogant and ignorant of the medications he gave my mom to prep for the procedure. So I asked around and took her to another doc in that practice, who we love. You can also look online at some of the ratings websites, but I think those aren't as helpful as nurses. They know what's really going on. If you need a cardiologist, then go to the hospital's heart floor, etc. Finding the right doc can make all of the difference in the world for your mom. Good luck!!
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From the Wall Street Journal (owned by Rupert Murdoch, a Conservative with a Capital "C") October 28, 2013: The headline of the article is, "Those Over 65 Need Not Fear the Affordable Care Act". The subhead is: ALICIA MUNNELL: The Affordable Care Act will have no impact on those 65 and over as they have Medicare. For people younger than 65, it will allow those who no longer have employer-provided coverage to buy affordable health care to tide them over until they, too, are eligible for Medicare.

Alicia Munnell is the director of the Center for Retirement Research at Boston College, where she also serves as the Peter F. Drucker Professor of Management Sciences at the Carroll School of Management.

From AARP's Factsheet about the ACA:The law strengthens Medicare by including more preventive benefits, lowering the price of prescription drugs in the Part D doughnut hole, and fighting waste and fraud.
Medicare is strengthened

Your guaranteed benefits are protected. You earned your Medicare over a lifetime of work. The health care law protects your guaranteed benefits so you can always get the care you need when you need it.

You get more from your Medicare

The health care law lowers prescription drug costs. If you have Medicare Part D, and you reach the coverage gap or “doughnut hole” in 2013, you will get more than a 50 percent discount on brand-name prescription drugs and more than a 20 percent discount on generic drugs while you are in the coverage gap. The discounts will continue to grow until 2020, when the gap will be a thing of the past.
More preventive care is covered. Medicare now covers yearly wellness visits and more preventive care. This includes cancer, cholesterol and diabetes screenings, immunizations, diet counseling and more.
The health care law fights fraud, scams and waste that take money from the Medicare program. The law strengthens Medicare by adding more resources to catch those who fraudulently bill Medicare.

Updated August 2013
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