November 13

Observation Coverage Explained

Are you confused about which type of plan is best for observation coverage? Ronnie James, Tidewater’s Training Director, explains which type of plan is the most reliable at covering expenses accrued during observation stays.

Are Observation Coverage 100% Under a Medicare Supplement Plan?

That's a great question. A lot of agents believe that they are 100% covered, and the services rendered at the hospital truly are covered under a Medicare Supplement plan. However, Medicare Supplement plans will not cover any drugs that are administered to the patient while in observation. 

Are Medications that Are Prescribed During Observation Covered?

While medical services are covered at 100%, you need to be aware that medications that are prescribed while there are not covered. It is very possible that your members could get a bill for medications that were taken while in observation, even if they have a Medicare Supplement.

This is a common misconception that agents have and it is a cause for concern. However, be aware that if someone is on a Medicare Advantage program and they go into observation, any medications that are prescribed while there are covered.

For example, if someone goes into the emergency room and gets put into observation while on a Medicare Advantage plan, the medications and rendered services would all be covered under the emergency room copay.

While medical services are covered at 100%, you need to be aware that medications that are prescribed while there are not covered.

Which Type of Plan is the Best Option for Observation Coverage?

It is a fact that someone who is in observation may actually pay less with a Medicare Advantage plan than they would with Original Medicare and a supplement.  

If you have any questions about observation stays or anything else, please don’t hesitate to give us a call at 888-622-9122. Our expert agent support team is always ready to help!

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