The Traps Within Medicare -- 2019 Edition: How to Spot Them, How to Avoid Them, and How to Optimize

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Medicare is a maze of pitfalls, traps and consequences wrapped in strange language and acronyms. Words often have quite different meanings than simple English would make us think. A normal human can easily reach very different conclusions after a discussion or research session, than that which is correct.A simple example: the word covered. When we're told that a procedure or treatment or visit is covered by Medicare, our normal English interpretation is that our costs are taken care of, is it not?This is not the case, not by a long shot. Covered, to the folks at Medicare, means that they will pay some part of the cost, leaving us with sometimes huge out-of-pocket expenses. And figuring out what part they will pay can be far from simple.To illustrate, let's consider medical bills "covered" under Part B of Medicare, the part that encompasses doctors' bills and outpatient treatments, for a common senior procedure -- a knee replacement. Most of these are now done in outpatient surgery centers; your doctor will say, and Medicare will confirm, that an outpatient knee replacement is covered by Part B. If you merely accept that language as plain English and assume that you can have the procedure without cost, you are in for a massive set of surprises.Covered under Part B means, at best, 80% of the costs are actually covered by Medicare payments. You pay a monthly premium of $135.50 in 2019 for Part B coverage. Then you pay a deductible, $185.00 in 2019, upon your first use of Part B benefits in the calendar year. But the biggest surprise of all is that you have to pay 20% "co-insurance" for all Part B charges -- plus an additional (up to) 15% for "excess charges" if your doctor elects to bill you for more than Medicare will pay.Let's run the numbers. Costs for a knee replacement will vary widely with doctors, facilities, and your specific condition and complications. To get into the ballpark, we looked at some reputable websites for data. Howmuchisit.org quotes a range of $40,000 to $80,000, all-in. Healthline.com estimates the average cost at $57,000. These amounts do not include the extensive after-care required, including a lot of physical therapy, also covered by Part B. If nursing home or in-home health care is required for you, these charges may or may NOT be covered, but that's a subject for another discussion.We will be very optimistic and estimate that your final tally of bills comes to $60,000, and are entirely covered by Part B. So before you get to skip on home from the outpatient center with your new knee, you will have to lighten your wallet by at least $12,185. Assuming there are no complications. If the doc thinks his work is worth billing you excess charges, add many thousands more. Is that a check you can afford to write, or will you have to grind about painfully on your old knee for the extra years it might take to accumulate that much cash?This book will guide you over, under, around or through all of the traps lying in wait for you within the Medicare maze. In a short 2 or 3 hour read, you will gain an education about the problems and the solutions within the systems that many professionals struggle to comprehend. You will become a truly informed consumer, prepared to grapple with your own set of constraints as you pass the milestone of "Happy 65th!"Decisions you make at this critical time, when most new seniors are totally unprepared for the complexities ahead, will either help you or hurt you for many years to come. Many are irrevocable. The solutions are affordable and relatively painless, for the well-informed. Read this book and join their ranks.


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