A Common Medicare Mix-Up

Richard Brown, better known as RD Brown, is a listener and a storyteller. And as a long-time BCBSND sales expert, he’s heard most every scenario possible when it comes to North Dakotans’ Medicare coverage.

“When people hit age 65, they’ve lived long enough to know someone who’s been through the unthinkable, when it comes to health,” he says. “And they want to share their stories.”

That experience helps give RD a realistic picture as he guides others in decisions around Medicare.

A common Medicare misperception
“People think of Medicare as if it’s the senior version of the insurance they previously had from an employer or purchased directly,” he says. 

Although there are similarities, the two are very different.

They’re alike in that there is cost sharing. Medicare pays 80 percent of an approved procedure and the patient pays 20 percent.

But here’s where the difference comes in. “When you had private insurance, there was a similar split,” he says. “But at some point, you would stop paying because you reach your out-of-pocket maximum.”

“With Medicare, there’s no out-of-pocket maximum to protect you, so you could be paying coinsurance endlessly.”

Stories help paint the picture
RD helps make the point with a recent example. A relative with a history of heart problems was feeling a little “off,” so upon advice from the phone nurse, the relative went to see her cardiologist.

That doctor decided on inserting a stent and did the procedure that day. The next morning, she went home and resumed her normal routine.

That overnight visit totaled up to nearly $50,000.

With an 80/20 Medicare split, Uncle Sam would pay $40,000. Without a Medicare supplement, the patient would pay $10,000. In this case, she had a supplement, so the ten grand was covered.

If she had had complications, the price tag would have kept climbing and her portion would have grown.

Now let’s think about another common procedure—a hip replacement – where the price tag is much higher. As a patient, you would still pay 20 percent, but of a much higher bill. A Medicare supplement covers that cost entirely.    

“I suggest everyone on Medicare get the most comprehensive supplement you can work into your budget,” he says. “When you’re recovering from some medical setback, you need to worry about getting healthy, not how you’re going to pay the medical bills.”

Learn more about Medicare.


RL 9.0