AARP Eye Center
@alexiss12 wrote:Also note that all Medicare insurance companies offer the Supplemental plans with very little difference in costs!
Medigap plans can vary in cost greatly - sometimes by your attained age or by your age when you get the supplemental policy. Cost also vary by state and area of a state.
On the other hand, a lot of Medicare beneficiaries can't afford a Medigap plan. They are financially wedged between not being able to afford a monthly premium for a supplemental plan (Medigap) to pick up that 20% of their Medicare cost and making or having too much to qualify for dual coverage with Medicare and Medicaid.
So they may pick a Medicare Advantage plan that works in their area.
Traditional Medicare can deny services. Have you never had to sign a Medicare ABN in a doctors office? It actually might mean that if you have [whatever] done, Medicare might not pay for the service and if Medicare doesn't pay, your supplemental won't pay either.
Medicare.gov - Advanced Beneficiary Notice of Noncoverage
When something medical is denied by Medicare, the care is usually already done and thus the provider tries to get the beneficiary to pay or if a hospital, it might be covered by Medicare's Bad Debt Fund.
Some beneficiary's might file an appeal for coverage- a long process of going back and forth with them about covering something. Medicare.gov - How do I file an appeal?
I filed one about a specific thing years ago and it took over a year with lots of correspondence, proof and medical info to get it paid. There are 5 different levels in the Medicare appeals process -
Medicare.gov - Filing an Appeal if you have original Medicare
Kind of like a property tax appeal, it goes from one level to the next if you keep appealing it. Finally, they did reimburse me - $ 250 - was it worth it in time and energy - NO - it was the principal of the thing, know what I mean. I usually go down fighting - only had to get to level 3.. 
There are a few things that have to have prior approval under traditional medicare - durable medical equipment and a few doctor services and of course, traditional Medicare does not cover all care but sometimes the beneficiary finds out about it after the fact - best to check or watch for those ABN's in a doctor office setting.
I haven't checked in a while but at one time in late 2016, Medicare had about 300,000 appeals in process -
One of the really BIG areas of appeals is when a beneficiary goes to the ER, doc keeps them but under an "observation status" - not a true "admission". Then they are sent to a skilled nursing facility without being ever officially admitted to a hospital for 3-consecutives days.
The rule states you need to be admitted as an inpatient for three consecutive days to qualify for a stay in a skilled nursing facility. ... Even if your hospital stay is longer than two midnights, those days cannot be converted to inpatient status after the fact.
So what happens is the SNF is not paid by Medicare.
The rule is still there - but in the last few years, the hospital now has to give you some written notice of your status in 24 hours. Still some people get caught in this debacle cause everybody doesn't understand it or have an advocate present.
I've learned to Never say Never and situations change between people.
Medicare.gov - Inpatient or outpatient hospital status affects your costs
"I downloaded AARP Perks to assist in staying connected and never missing out on a discount!" -LeeshaD341679
