Medicare – is it what you expected?


As one friend said to me, I waited so long to get on Medicare and I’m still paying out the wazoo for nothing!  Medicare – is it what we expected?

Another friend told me, “I’ve been pushed out to pasture. No one cares.”

Here are some practical suggestions once you get on Medicare.

Enrollment is at the end of the year unless you are turning 65.

Get yourself a professional who can talk to you about enrollment and what you are going to need.

Do not go to the grocery store and talk to the person sitting behind a table about your medicare.  They work off commission.

Read the fine print and ask your professional insurance broker to go over the details with you.

Make sure they are available to answer your questions throughout the year.

Do not expect your insurance company to help.  You will be lucky to get someone on the phone.

If you do get someone on the phone, you may get a second answer which is nothing like the first answer.

Do not make assumptions.

Never pay a bill without clarifying it through your insurance broker.

Document everything: Who you spoke to, when you spoke to them, employee ID, and what they said.

Trust but verify.  Over and over again.  Are these providers, medications, and services in my network.

If you have questions, call your insurance broker.

What you must understand

Medicare is government insurance.  It is federal insurance.  The risk is spread throughout the aging population.

Doctors are limited as to what they can do and order for you when you are on Medicare.

To keep costs down, Medicare sets rules and decides what preventive tests will be paid for.

Medicare has an agreement with all those providers who participate to pay a certain amount for the services you require.

For example:  If your shoulder replacement operation costs $285000, then the hospital and doctor might get $20,000.

As one doctor explained it to me like this:  “Suzanne, it’s a game we play.  Let’s say Medicare tells us they will pay 7% of what we charge.  In order to meet our costs, (we need $20,000) we will ask for $285,714.00 so we can get the $20,000. The problem is the poor patient who still has to pay a deductible and copay which means the prices had to be jacked up so Medicare would reimburse us the 7% they promised. It’s the patient who suffers.”

On another note, if Medicare will not pay, you will need secondary insurance to cover what Medicare will not pay.  This becomes expensive, and then there’s medication insurance which all must carry.  This is another expense.  If you have Medicare and take no medications, you still must have drug insurance.

Why can’t Medicare just pay what they are supposed to?

After all, after all, isn’t medicine supposed to be transparent for all to see what’s really going on?

Need to find a great insurance broker? Honest? Trustworthy?

The Caregiver’s FREEDOM CLUB, where members stay ahead of the games.



We are here to help caregivers and their seniors get through the maze of chaos.

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Suzanne FiscelIa, PA-C, BCPA

I know exactly what it's like to feel like you just can't keep up. Working a full-time job, raising 3 children as a single mom, and taking care of her aging mother. But after feeling lost, overwhelmed, and guilty for spreading herself too thin, I saw all her patients and their caregivers going through the same thing. I learned how to put simple systems in place to keep my life free from distractions, find free time to do the things I wanted, and enjoy my family along the way. These simple step-by-step solutions have been shared with my patients, friends, and family. They too have found organization, confidence, peace, and freedom. Now we all live the life we love while caregiving! Come join us!

Hi I'm Suzanne

And my mission is to find you practical easy-to-follow solutions for everyday caregiving. Find out more HERE.

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