Does the No Surprises Act Protect Seniors Against Unanticipated Medical Bills?

Ever open your mailbox to find a surprise medical bill you completely did not expect? Perhaps you had an emergency and had to go to the nearest doctor or hospital to receive care? What if you were not yet on Medicare or have a Medicare advantage plan and had to use an out-of-network provider? Surprise medical bills arise more than you think!

Surprise Bills Are a Major Concern for American Seniors — Does the Newly Enacted Plan Protect Them?

Surprise bills lead the list of affordability concerns for many seniors and other American individuals and families. Here are some interesting facts about this:

– Two in three adults say they worry about unexpected medical bills, more than the number worried about affording other health care or household expenses.

– Surprise bills can number in the millions each year.

– Among privately insured patients, an estimated one in five emergency claims and one in six in-network hospitalizations include at least one out-of-network bill.

– Balance billing on surprise medical bills can reach hundreds or even thousands of dollars. Plans might pay a portion of the bill but leave the patient liable for the balance – the difference between the undiscounted fee charged by the out-of-network provider and the amount reimbursed by the private health plan. Keep in mind that if you’re on Medicare or Medicaid – balance billing is prohibited.

Luckily, starting January 1, 2022, Americans may no longer be responsible for surprise bills!

The No Surprises Act Provides New Protections Against Surprise Medical Bills

In the closing days of 2020, Congress enacted and the president signed into law the No Surprises Act, providing new federal consumer protections against surprise medical bills. The measure’s enactment followed two years of congressional debate over competing approaches, where at times, Congress appeared to be deadlocked.

The No Surprises Act contains key protections to hold consumers harmless from the cost of unanticipated out-of-network medical bills. If you get health coverage through your employer, a Health Insurance Marketplace, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

• Ban surprise bills for most emergency services, even if you get them out-of-network and without prior authorization.

• Ban out-of-network cost-sharing (like out-of-network co-insurance or co-payments) for most emergency and some nonemergency services. You can’t be charged more than in-network cost-sharing for these services.

• Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.

• Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections.

Keep in mind that people with Medicare and Medicaid health insurance already enjoy these protections and are not at risk for surprise billing. Yet, there are things that those who already have these programs or who anticipate having them in the future can do to future-proof their health care costs.

Understanding Medicare and Future-Proofing Your Health Costs

When seniors turn 65, they gain access to Medicare. Medicare provides medical care for retirees with little to no out-of-pocket expense. This means that, for the most part, your routine medical care is not going to cost you a lot if you are on Medicare!

Unfortunately, there are some very serious limitations and gaps when it comes to Medicare and what it provides. Long-term care, for instance, isn’t provided for by Medicare. If you do need this type of coverage (which is incredibly expensive), you need to pay out of pocket, or plan with an experienced elder law attorney, such as myself.

If you have original Medicare, sometimes called traditional Medicare, it is also wise to invest in a Medicare supplement plan (sometimes called a Medigap plan, which covers many of the gaps in care that original Medicare does not pay for).

Strategies to Help You Avoid Worrying About High Medical Costs

As you can see, if you are not yet 65 and/or not on Medicare, you can take advantage of the No Surprises act if you need to do so:

– Make sure your home or wherever you reside is safe: Ensuring that your place of residence is safe and free from hazards, equipped with technology, and that care giving help is available and there to assist, reduces the chances that you or a loved one will suffer an injury in your home. It’s all too easy to fall down a flight of stairs, slip and fall in the bathroom, or become injured cleaning an unused room, shoveling snow, or even just taking out the garbage.

– Increase your savings activity prior to retirement: Experienced financial planners can help you take a good look at your retirement plan, point out places where you might need some assistance, and suggest steps to take to ensure you’ll be in good shape when you retire and that you’ll be prepared for unexpected costs (including health care and long-term care costs) that are likely to come your way as you get older.

– Know what to expect from Medicare and Medicare Advantage: If you’re receiving Social Security at age 65, you’ll be enrolled automatically in Original Medicare Parts A (hospital) and B (medical). You can also add Part D (drug coverage). Costs for Medicare include a deductible and premiums, deductibles and co-insurance for Parts B and D. You can purchase Medigap to help with expenses Medicare doesn’t cover.

– Be realistic about costs, even if you’re healthy: Be sure to include the costs of premiums and out-of-pocket expenses in your retirement budget. In general, you can plan on spending about $850−$1,150 a month (or $10,200−$13,500 a year) before age 65. When Medicare kicks in at age 65, you can plan on spending about $450−$600 a month (or $5,400−$7,200 a year), according to Kaiser Health. For a more accurate estimate based on where you live, inflation, and other factors, consider talking to a financial planner such as myself.

– Consider how you’ll cover long-term care: A majority of people over 65 will need some type of long-term care at some point, and the costs can be astronomically high. Hybrid long-term care/life insurance can help cover costs if you or your spouse need assisted living or nursing level care, whether at home or in a facility. It is also important to discuss Medicaid Asset Protection with an experienced elder law attorney to plan for long-term care without having to use all of the money you’ve worked your entire life to earn.

Medicaid Laws Are the Most Complex and Confusing Laws in Existence. We Can Help!

If you or a loved one is nearing the need for assisted living or nursing home level care, or already receiving assisted living or nursing home level care, we can help to legally protect your family’s hard-earned assets from the catastrophic costs of nursing home care.

Nursing homes in Metro DC area cost $10,000 – $14,000 a month. Generally, the earlier someone plans for long-term care needs, the better. But it’s never too late to begin the process of Long-term Care Planning, also called Lifecare Planning, Medicaid Asset Protection Planning, or just Medicaid Planning.

Medicaid laws are the most complex and confusing laws in existence, and impossible to understand without highly experienced legal assistance. Without proper planning and legal advice from an experienced elder law attorney, many people spend much more than they should on long-term care and unnecessarily jeopardize their future care and well-being, as well as the security of their family. Please call us at any time to make an appointment for an initial consultation:

Medicaid Asset Protection Attorney Fairfax: 703-691-1888
Medicaid Asset Protection Attorney Fredericksburg: 540-479-143
Medicaid Asset Protection Attorney Rockville: 301-519-8041
Medicaid Asset Protection Attorney DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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