Hundreds of thousands of people will be able to appeal hospitals’ decisions to classify them as “observation care” patients instead of inpatients, under a ruling last week in a class action suit.
Members of Congress and others complain Medicare’s revamped Plan Finder had problems. Federal officials say they can help consumers who got bad information change their plans next year. But details about how switching will work are yet to come.
For more than a decade, customers used the online plan finder to compare dozens of policies. Yet after a redesign of the website, the search results no longer list which plan offers a customer the best value. Federal officials say it will be fixed before enrollment begins next week.
Medicare beneficiaries under observation care in the hospital can face higher costs for treatment and are not covered for nursing home care when discharged. A federal trial in Hartford, Conn., will determine whether the government’s ban on appeals involving observation care coverage is fair.
The problem affects private drug policies and Medicare Advantage plans that provide both medical and drug coverage and substitute for traditional government-run Medicare. It could leave plan members without coverage.
El problema abarca a la cobertura de medicamentos recetados (Medicare parte D) y a los beneficiarios que tienen planes médicos de Medicare Advantage.
Federal officials are hailing the introduction of services such as transportation to medical appointments, home-delivered meals and installation of wheelchair ramps as a way to keep beneficiaries healthy and avoid costly hospitalizations. But not many plans are offering the services in 2019.
Congress approved two bills last month that prohibit provisions keeping pharmacists from telling patients when they can save money by paying the cash price instead of the price negotiated by their insurance plan.
Federal officials are allowing the private insurance plans to use “step therapy” for drugs administered by doctors. In step therapy, patients must first use cheaper drugs to see if they work before receiving more expensive options.
Beneficiarios de Medicare pueden conseguir medicamentos más baratos si pagan en efectivo… pero por reglas mordaza el farmacéutico no puede decirlo.