Medicare Advantage insurance can be tricky

George, an 85-year-old, was surprised when he received a $4,000 bill for his pacemaker replacement procedure, after he was told that it would cost him $250.

He had called his Medicare Advantage plan before the procedure and was told that he would be responsible for a $250 inpatient hospital co-pay. Unfortunately, the hospital and the doctor’s office did not tell him that his procedure would be done as an outpatient with an overnight stay. He stayed overnight, but since he was never an inpatient, the bill was applied to his $6,500 deductible for outpatient services.

It’s a constant refrain! You’re a senior, on Medicare, you do everything you are told but somehow you still owe $4,000. Again, insurance companies do not watch out for seniors and make the simplest of “medical procedures” complicated.

Understanding your insurance can be like playing a game with no rules. It doesn’t matter what plan you choose, there is still many a “slip between cup and lip.” No other industry in the U.S. is allowed to operate this way. It’s illegal!

This is especially true if you have a Medicare Advantage plan. These plans are less expensive than regular Medicare with a supplement for a reason. They may add extra benefits, but they are often more complicated to understand. So what do you need to do to avoid surprises or issues? Plan ahead, ask a lot of questions and advocate for yourself, your partner, your family members or call Parent Your Parents.

Parent Your Parents has added Anne McGuire, RN to its growing group of experts. Besides being a RN, she also is a certified case manager and knows the pitfalls of senior insurance issues. Please go to our website, ParentYourParents.com, to see her photo and biography. We will be col-laborating on more articles to assist you with getting through the insurance maze — little things like what to do if you are sent to the emergency room.

Bottom line: Remember insurance for any medical procedure can be very tricky. The intricacies of how Medicare Advantage plans work and the medical billing system are not for the feint of heart!

Frances Reaves, Esq., a graduate of the University of Miami Law School, spent 10 years as a litigator/lobbyist. Today, she Is an accomplished business woman who, when her parents could no longer take care of themselves, learned the ins and outs of senior care (or the lack thereof). She founded Parent Your Parents to assist seniors and their children through the myriad pitfalls and options of “senior care” in the 21st Century. If you have any questions or comments contact Frances at hfrancesr@parentyourparents.com.


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