Social Security & Medicare Questions: Choosing a Hospital

Social Security & Medicare Questions: Choosing a Hospital

Q: I’m 65 and enrolled in Medicare. I need to undergo a routine surgery. There are several hospitals in my area and my doctor asked me which one I wanted to use. Since I’m new to this area, I wasn’t sure. Any suggestions?

A: When you need to enter the hospital for surgery or another reason, your focus should be on getting the best care. Choosing the right hospital can make a big difference to the outcome of your surgery, avoiding unnecessary medical procedures, and in what you pay out-of-pocket costs. Here are a few guidelines.

Check the quality of care: Research indicates that some hospitals do a better job than others. Look for hospitals that are rated highly by your state, consumer or other groups. Is your choice of surgeon important? If so, choose a hospital where your doctor has admitting “privileges.” Learn the experience the hospital and your surgeon have with your condition, and their track record with patients having conditions like yours.

Check ratings: You can check hospital ratings online for free at Medicare’s web site using the Hospital Compare database. The information is OK to start your search, but not very meaningful. Recently the government added new information showing hospitals where Medicare patients are incurring especially high bills. This may be important to consider when out-of-pocket costs are of particular concern. A more user-friendly choice of hospital ratings is Consumer The website requires a modest subscription, but the hospital comparisons are easier to understand. There’s also a wealth of consumer information, resources and links to help you choose.

What does your insurance cover? Understanding your Medicare coverage is essential to help you avoid surprises when the hospital bills come. While some-out-of-pocket costs may be expected (depending on whether you have a Medigap or Medicare Advantage plan), there’s a lot you can do to prevent unnecessary costs and errors. Before making a decision about any hospital, call your insurer and get a list of hospitals that are in your Medicare supplement’s or Medicare Advantage plan’s network. The same is true for your surgeon. Go outside your insurer’s network, and you will pay substantially more out-of pocket. Worse, if you go to a hospital that doesn’t participate with your plan at all, neither your plan nor Medicare may cover the cost. You would need to pay entirely out-of-pocket. Find out from your insurer whether your procedure requires pre-authorization.