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Legislation to curb out-of-pocket costs after hospital


Improving Access to Medicare Coverage Act — a bipartisan bill in the U.S. House and Senate to help confront the large out-of-pocket costs people in Medicare can face as the result of a hospital observation stay — has received a nod from AARP.

The legislation, sponsored by Sens. John Kerry, D-MA, and Olympia Snowe, R-Maine, and Reps. Joe Courtney, D-Conn., and Tom Latham, R-Iowa, aims to make it easier for patients to qualify for Medicare coverage of skilled nursing care once they leave the hospital so they may receive essential follow-up care.

“Seniors should not face huge, unanticipated medical bills — or risk being denied coverage, period — because of a little-known distinction between an inpatient hospital stay and hospital observation,” said Deborah Banda, state director of AARP Massachusetts, which represents more than 800,000 members age 50 and older in the Bay State.  “It places a significant and unnecessary burden on those seniors in Medicare who require essential follow-up care.”  According to a recent survey by AARP, the majority (88%) of Massachusetts residents age 50 plus say Medicare is extremely or very important to them.

To receive Medicare coverage of skilled nursing facility care, patients must have been admitted to the hospital as an inpatient for at least three consecutive days. Increasingly, however, hospitals are choosing to “observe” patients, rather than admit them. As a result, some patients have been saddled with high out-of-pocket costs for follow-up care, or have gone without care altogether. The legislation aims to offer patients relief by applying time in the hospital under observation toward the three-day requirement for Medicare coverage of skilled nursing care and would establish a 90-day appeal period for people who have a qualifying hospital stay and have been denied skilled nursing facility care after January 1, 2011.

In a letter to the lawmakers sponsoring the bill, AARP noted the legislation would help some people in Medicare receive the services they need and reduce their out-of-pocket expenses.

“When senior citizens get sick they need to know that they’ll get the care they need. The last thing they should have to worry about is a billing technicality that could saddle them with outrageous out of pocket costs,” Senator Kerry said. “This bill will eliminate an unnecessary financial hardship on Medicare beneficiaries that can stand in the way of the skilled nursing care they need. I look forward to working with Senator Snowe and Congressman Courtney to bring some peace of mind to patients and their families.”

“These members of Congress are working collaboratively to ease the burden of Medicare patients – and overcome the partisanship that has too frequently stalled progress in Washington,” Banda added.  “We are happy to be working with lawmakers on both sides of the aisle to improve health care delivery for older Americans.”

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