As I was getting ready to walk out the door to meet Ruth for lunch, Janet called. Janet recently got home from five (5) days in the hospital and has already received her hospital bill. She said, “Medicare did not pay anything on my hospital bill.” I reminded her that, since she has a Medicare Advantage plan, her bills are paid by her Medicare Advantage plan not Medicare.
Here’s a little of Janet’s history. Before she turned 65, she called to talk about Medicare options. We talked about Medicare Supplement and Medicare Advantage plans – the benefits provided as well as her monthly premium. Which fit in her budget? And not only the monthly premium, but what she could potentially owe when she needs care. Janet’s budget was tight, and she was unsure of her “retirement” income. She liked the Medicare Supplement plan and the idea of paying a monthly premium then owing very little when she went to the doctor or hospital or had tests run (the $233 Part B deductible in 2022). But the monthly premium did not comfortably fit in her budget. Since Janet was healthy, went to the doctor seldom and didn’t have much medical history, she was interested in the -0- premium (no monthly premium) Medicare Advantage plan. We talked about the benefits and potential charges/expenses she might have to pay when she goes to the doctor(s) or hospital or has tests run. The plan she liked has no copay when she goes to her primary care doctor but there is a copay when she goes to a specialist. Depending on what else she has done, some services have a copay, and some do not. If she is admitted to the hospital, she would have to pay $375 a day for days 1 through 5. Even if she has lots of doctor visits, many tests run, Janet will have a maximum that she could be out-of-pocket (that she would have to pay). This assumes she goes to “in network” providers. The next step was to make certain her doctors and hospital were in the network – they were. Then we checked her prescriptions. The prescriptions copays were low and manageable. Janet was willing to “take a chance” on the Medicare Advantage plan and knew she needed to make certain she went to “in network” providers. Every year Janet tells me she likes her plan and it’s working great for her. She does not want to make any changes. Then . . . this year she went to the hospital and got an unexpected bill for $1875 ($375 per day for 5 days stay in the hospital) – not in her budget. She was familiar with her Medicare Advantage plan and the potential hospital costs – she just was not expecting that bill. What works better for you? Low/no monthly premium and “pay as you go” or pay a monthly premium and avoid surprise bills? I’d like to hear from you - call me at 501-868-6650 and say “Caroline, can we talk?”
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AuthorCaroline Beauchamp specializes in personalized life and health insurance solutions. Archives
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