6.5 Things Medicare Won’t Tell You

There are 6.5 things Medicare won’t tell you when you first sign up . . . or never. These 6.5 things will catch you by surprise and cost you money. You can prepare and plan ahead, but only if you know what to expect.

You usually have to learn them the hard way . . . on your own. By then it is too late. 6 things Medicare won't tell you

If you are like most of us, you remember watching Lassie on TV. Lassie was the smartest dog in the world and could do anything. If Timmy was in the well, Lassie would run for help and simply by barking, humans would know exactly what was wrong and to let Lassie show them the problem.

Lassie is not here to warn you about the pitfalls of Medicare but maybe we can help.




Lesson One – Medicare Doesn’t Pay For Everything


Probably not.

Medicare is not an “all you can eat” health care buffet. Medicare pays for some things, but you have to pay the rest.

Original Medicare is nice. Some of it is “free”, some is not.

old man scratching headIf you or your spouse worked in the Social Security system for enough years you have earned the free part. Most seniors will get Medicare Part A at no charge.

But you have to pay for Part B if you want coverage for doctor visits, lab work, scans, physical therapy, chemotherapy, radiation therapy, dialysis and other outpatient services.

Not only will you pay a monthly or quarterly premium for Medicare Part B, but you will also have to pay deductibles and coinsurance.

Most think a hospital stay will ruin you financially. It can, but over half of all claims over $50,000 are incurred under Medicare Part B as an outpatient.

One of the 6.5 things Medicare doesn’t tell you is they only pay about 80% of your medical bills. You pay the rest.

As a general rule, Medicare does not cover you when you travel outside the United States. If you plan on traveling outside the country, even on a cruise, we recommend a travel medical plan such as Atlas Travel.

Medicare also does not cover

  • routine eye exams
  • routine dental work
  • hearing aids or hearing exams
  • custodial care
  • outpatient prescription drugs

Medicare Part D is an optional benefit available to Medicare beneficiaries. Currently Medicare drug plans start at $12 per month and go up from there. Medigap clients of Bob Vineyard receive expert guidance in selecting the right drug plan based on your needs and budget. Often you can combine Part D with mail order and in some cases, patient assistance programs which can save you thousands of dollars each year.

If you want to choose (or keep) your own doctor rather than being assigned to one, you will want a good Medicare supplement plan to help pay the 20% not paid by Medicare. With over 170 Georgia Medigap plans to pick from, how do you know which one is right?

We can help you. Bob Vineyard at Medicare Plans of Georgia has over 35 years in the industry and understands your needs. You can shop and compare rates in the comfort of your home by clicking this link.

Your information will not be sold. You will see various plans and rates INSTANTLY and receive a welcome email a short time later.



Lesson 2 – Some Doctors Don’t Like Medicare

That’s another of the 6.5 things Medicare won’t tell you.

Medicare Part BMore than half the doctors in Georgia do not accept any Medicare Advantage plans and the ones that do only take a few of the plans. You are probably asking yourself, what is the advantage to an Advantage plan if I can’t use it?

Good question.

Original Medicare and any Medicare supplement plan, also referred to as Medigap, is accepted by any doctor, lab or hospital anywhere in the United States.

Medigap plans are standardized, making them easy to compare one plan with another.

The plans are similar but the premiums aren’t. Depending on the carrier you choose, the same plan can range in premium by $100 per month or more from the lowest to the highest. When you pay more you don’t get more, you simply paid too much.

We can show you where the value plans are so you don’t have to pay more than you should. We save our clients $600 a year or even more by helping them find the right plan that fits their needs and budget.


Lesson 3 – Fraud Prevention is Not Medicare’s Strong Suit

Medicare pays for a lot of things they shouldn’t. That means you pay more for your care.

Some doctors don’t like the fact that Medicare pays them less than private insurance and they try to make up for the loss by padding their bill. Medicare relies on you to be a watchdog. You can help yourself, and preserve the medicare fraudfinancial integrity of Medicare by reviewing your bill and reporting charges for items and services you did not receive. Review your Medicare Summary Notice and check for errors. You could collect up to $1,000 for reporting fraud. Here is what you need before you call.


  • Have your providers name and identification number
  • The service or item you are reporting
  • The date(s) of service
  • How much was approved and paid by Medicare
  • The date on your MSN
  • Your name and Medicare number
  • Why you think Medicare should not have paid this claim

Call 1-800-MEDICARE to report fraud and abuse.

Just because Medicare pays 80% of the cost of services you are responsible for the other 20%. An affordable Medicare supplement plan makes budgeting for high medical expenses possible.


Lesson 4 – Medicare is in Bad Shape

All the talk about Medicare going broke?

It’s true.

And to make matters worse, Obamacare reduces funding for Medicare in order to provide free and highly subsidized health insurance to people under age 65 that fall below 400% of the Federal Poverty Level.

Currently thats about $62,000 per year for a couple.

So how bad is it?

One of the 6.5 things Medicare won’t tell you is that, by comparison, Social Security is in good shape. A couple with average annual wages of $44,000 will have paid in roughly $700,000 in Social Security taxes over their working lifetime and will receive around $620,000 in Social Security benefits.

That same couple will have paid $153.000 in lifetime Medicare taxes while collecting around $427,000 in Medicare benefits.

In health insurance parlance we call that a money hole.

What can you do?

Tell your Congress critter you don’t want Medicare cut to fund health insurance for able bodied individuals under age 65.

You can also protect your savings with an affordable Medigap plan that covers your Medicare deductibles and coinsurance. With more than 170 Medicare supplement plans to pick from, how do you know which one is best for you?

Let us help you make it through the maze.


Lesson 5 – That’s Not Your Cash!

Have you been injured in an accident? Are you a victim of malpractice? Were you awarded a settlement for medical injuries?   medicare bills not paid

Don’t spend your money yet. Medicare wants a piece of it.

Any medical bills paid by Medicare that are later reimbursed due to civil settlements are subject to recapture by Medicare. According to CMS, Medicare must be paid within 60 days of receipt of judgement monies.



Lesson 5.5 – Medicare and Group Health Insurance Plans Don’t Play Nice

Let’s say you are covered under an employer provided group health insurance plan. Do you need Medicare and the group health plan? Who pays first?

It depends . . .

If you are covered as an active employee and the company has fewer than 20 employees, Medicare Part A and B pays first. Your group plan coordinates on the balance.

If there are more than 20 employees, the group health plan pays first and Medicare . . . probably pays nothing. You may not need Medicare Part B or D as long as you are covered as an active employee.

But what about retiree health insurance plans? Who pays first there?

Medicare does. Unless your retiree plan is free or almost free, you may not want it.



Lesson 6 – How Good is a Free Medicare Plan?

You may have heard about Medicare plans with $0 premiums. You may be enrolled in such a plan.

What is better than free?

no free lunchFor starters, it’s not free. On average, Medicare pays carriers that offer Medicare Advantage plans about $850 per month to provide benefits. Some of those plans require you to pay a premium of $40 per month or more, and some have $0 premiums.

$0 sounds awfully good and it is.

Until you try to use the plan.

One of the 6.5 things you may never know about these Advantage plans is they can leave you with hundreds or thousands of dollars out of pocke when you need the plan the most. Most of these plans have limited doctor networks. Fewer than half the doctors in Georgia participate in ANY Advantage plans and the ones that do may not take your particular plan.

Use a doctor or facility that is out of network and the financial penalty can be severre. You may not have any coverage at all for out of network charges. If those charges are covered they are usually subject to a separate deductible plus higher copay’s and higher out of pocket limits.

That “free” plan can cost you thousands of dollars in unpaid medical bills.


Final Lesson – What Can You Do?

Medicare is a confusing maze with their own terminology and way of doing things. Forget everything you thought you knew about health insurance. Most of it no longer applies.rachel v

Even if you have bought your own insurance over the years, navigating the Medicare system is not a DIY project.

Trust me.

I have worked in the health insurance industry since 1975 and in Medicare for the last four. I thought transitioning to Medicare would be easy.

It wasn’t.

Original Medicare is challenging enough. Add in the different parts (including Part D), supplement plans (usually called Medigap), Advantage plans and all the rest and you have a web of confusion.

Confusion comes standard with Medicare. There is no extra charge for that.

And confusion is another of the 6.5 things Medicare doesn’t tell you.