Can I Stay in the Hospital Without Paying My Medicare Deductible?
This article was updated on: 09/16/2018
If you are a Medicare beneficiary and you go to the hospital, the hospital cannot refuse to admit or treat you based on lack of payment of your Medicare Part A deductible. In 2018, this amount is $1,340. Additionally, if you seek emergency treatment, you will have access to emergency services regardless of ability to pay, according to the Emergency Medical Treatment & Labor Act. The Center for Medicare and Medicaid Services (CMS) has very strict guidelines on when and how a hospital or other health care provider can collect a Medicare deductible or copayment amount from beneficiaries. Here’s what you need to know.
Can a hospital request prepayment of a Medicare hospital deductible before admitting me?
CMS guidelines explicitly state that a hospital may not request prepayment of any Medicare deductible or copayment as a condition for admission or treatment, except in the very rare cases where the hospital has a policy of requesting prepayment from other patients who are not Medicare beneficiaries.
The guidelines further state that should the hospital make a prepayment request, it must be presented clearly as a request “without undue pressure.” There should never be any suggestion that you or your loved one will not get necessary care and treatment if you cannot or do not pay your Medicare deductible in advance.
CMS strongly encourages any hospitals or other health-care facilities that request prepayment to post a sign clearly stating that no one will be refused admission or medical care if he or she is unable to pay the Medicare deductible or other advance deposit.
Can a hospital deny any treatment while I’m a patient if I haven’t paid my Medicare deductible?
The rules in this situation are also quite clear:
- If you have not exhausted your inpatient hospital benefits under Part A, the hospital generally cannot deny treatment or demand payment of your Medicare hospital deductible or copayment.
- If you have exhausted your covered inpatient days under Part A, the hospital generally may apply the same prepayment policy it has in place for uninsured patients. This policy may vary from hospital to hospital, so be sure to talk to someone in the billing department if you are concerned that your inpatient benefits may run out during your admission.
Keep in mind, however, that the hospital may require prepayment for services such as comfort items (such as televisions, radios, and beauty and barber services) and private duty nursing that are not covered by Medicare. If you do not make the required payment or deposit, the hospital may deny you those non-covered items and services while you are an inpatient in the hospital.
If you have not enrolled in Medicare Part B (medical insurance) or a Medicare Advantage plan, and you don’t have other health insurance, the hospital may ask you to pay a deposit or show proof of ability to pay for the services of any staff doctor who might treat you during your stay.
Can a hospital force me to leave if I can’t pay my Medicare deductible?
If the hospital wants to discharge you and you don’t agree for any reason, you have the right to request a fast-track appeal from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Within two days of your admission, the hospital must provide you with a notice called “An Important Message,” or IM, about your rights under Medicare. This notice has contact information for the BFCC-QIO and instructions on how to request a fast appeal.
The hospital cannot force you to leave during the appeal process if you’ve followed the instructions and are within the appeal time frame.
How can I get help paying my Medicare hospital deductible?
If you are enrolled in Original Medicare (Part A and Part B) and are concerned about your out-of-pocket Medicare expenses, you may be eligible for a Medicare Supplement insurance plan, or Medigap. These plans may cover all or part of your Part A and Part B copayment/coinsurance amounts and also extend your inpatient benefits. Some Medicare Supplement plans may cover your Part A and/or Part B deductible.
You must have both Part A and Part B to enroll in a Medicare Supplement plan; the plans only work with Original Medicare and can’t be used to help pay the out-of-pocket costs of a Medicare Advantage plan. You also cannot buy a Medicare Supplement plan if you have a Medicare Medical Savings Account (MSA). You will pay a separate monthly premium for your Medicare Supplement plan in addition to your Part B premium.
Medicare Supplement plans are offered by private insurance companies. Not all plan types may be available in all areas.
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