Jane’s Surprise Bill… A Medicare Wake-Up Call
Jane, a 68-year-old retiree, thought she had everything under control. She’d enrolled in Medicare, made it through hip surgery without a hitch after her fall, followed all discharge instructions, and had her doctor follow up scheduled. But a few weeks after she got home, she opened her mailbox.
She froze…
Inside were 3 bills totaling over $10,000.
The were hospital invoices with charges for lab fees, surgeon’s fee, consult fees, imaging costs, and physical and occupational therapy. Sure, Medicare had paid part of it, but there were still thousands left for Jane to pay out-of-pocket.
Her first thought? “Wait… isn’t Medicare supposed to cover this?”
Sadly, this is an all too common moment for many seniors. The good news? It doesn’t have to be this way. This article will break down Medicare Parts A, B, and D in plain language and explain why Medicare Supplement plans (also called Medigap) are one of the smartest tools you can use to protect yourself from surprise medical bills. I will also give you a quick review of Medicare Advantage (Part C), which I will cover in more separate article.
Let’s help you avoid Jane’s scenario and keep more money in your pocket!
Medicare Part A: What It Covers — and Why You’ll Still Have Bills
Medicare Part A is often called “hospital insurance.” It’s the part of Medicare that helps cover:
✅ Hospital stays
✅ Skilled nursing facility (SNF) rehab care after a “qualifying” hospital stay or part of the Waiver program.
✅ Hospice care
✅ Some home health care
But here’s the kicker: it’s not free after the first few days.
For 2025, here’s what you’re looking at and how Jane found herself in this situation above:
- There is a $1,676 deductible per benefit period
- Days 1–60: $0 per day (whew…good news!)
- Days 61–90: $419 per day
- Days 91–150: $838 per day (these are your “Lifetime Reserve” days)
- After 150 days: You pay everything
Now, even rehab or skilled nursing care comes with a catch — after 20 days, you’re on the hook for $209 per day, after the 100th day. After day 100, you’ll be responsible for the full cost.
Without a Supplement plan, a week in the hospital and a couple of weeks of rehab can leave you with a bill that looks a lot like Jane’s.
As I write this, I am trying hard to bite my tongue and am disgusted with the Medicare coverage this country offers their seniors, elderly and disabled. Medicare insurance absolutely calls for supplemental insurance, or the financial results can be devastating.
Medicare Part B: Why Outpatient Care Can Still Hit Your Wallet Hard
Part B is your outpatient coverage — think:
✅ Doctor visits
✅ Specialist appointments
✅ Outpatient surgeries
✅ Lab work
✅ Imaging (like MRIs or X-rays)
✅ Durable medical equipment (like walkers or oxygen)
Here’s what you need to know about the costs:
- Monthly premium: $185 in 2025 (even higher if you have a higher income)
- Annual deductible: $257
- **After you pay the deductible: you pay 20% of the Medicare-approved amount
That 20% adds up fast, especially if you need surgery, chemotherapy, frequent doctor visits, or expensive equipment.
So you have $10,000 outpatient surgery? You could owe $2,000 — and that’s just one example.
Medicare Part D: Prescription Drug Coverage
Part D is your prescription drug coverage. It’s an essential add-on unless you want to pay full price at the pharmacy or have some other prescription coverage. For example, some employers offer lifetime pharmacy coverage post retirement.
Here’s what you’re dealing with:
- Monthly premium (varies by plan)
- Medicare Part D, the average monthly premium for 2025 is projected to be around $46.50. I will try and break this down further: this includes both stand-alone Part D plans and those bundled with Medicare Advantage (MA) plans.
- If you’re looking at a stand-alone Part D plan, the average premium is expected to be closer to $40.00
- Annual deductible (up to $590 in 2025, depending on the plan – some may have $0)
- Copays or coinsurance for medications
- Now, once the Medicare insured with Part D coverage reaches $2,000 out of pocket in a calendar year, then your co-pay is $0. The dreaded coverage gap (or “donut hole”), where you had to spend around $5,000 on drugs been discontinued beginning in 2025!
Skipping Part D because “I’m healthy” can backfire. One new prescription can turn into hundreds per month, actually thousands with the newer brand medications.
Medicare Supplements (Medicare G): How They Help You Sleep Better at Night
This is where the magic happens with a financial safety net.
Medicare Supplements, also known as Medigap plans help pay for the gaps left by Parts A and B. They cover things like:
✅ Part A coinsurance and hospital costs
✅ Part B coinsurance and copays
✅ Skilled nursing coinsurance
✅ Part A deductible
✅ Emergency care abroad when we travel (depending on the plan)
Why do people love Medigap Supplement Plans?
- You can predict your out-of-pocket costs
- You’re protected from big, unexpected bills
- You can go to any doctor or hospital that takes Medicare
- No networks or referrals needed
Popular plans like Medigap and Supplement Plans cover almost everything except the Part B deductible. For many seniors, this peace of mind is worth every penny.
Medicare Advantage (Part C): A Quick Mention Before We Dive Deep Later
Leave it to Medicare to bust up the alphabet by throwing out the C for the Managed Medicare Advantage plans without any chronological sense. Medicare Advantage Plans (Part C) is an alternative to original straight Medicare. They roll Parts A and B (and often D) into one plan, usually with extra benefits like vision, dental, and hearing. More in depth analysis and education on this to follow.
In a nutshell, they often have lower monthly premiums, but you’ll have co-pays, deductibles, and networks. But, don’t get too excited. All American Healthcare comes with its special way of letting down the generations before us after they have worked their whole lives to build said country, only to be offered subpar healthcare coverage.
If you want to compare Medicare Advantage vs. Original Medicare with Supplements, just stay tuned, as we are covering that in its own full article.
You Have More Control Than You Think
I understand this can be frightening or anxiety producing. But, here is the bottom line… Medicare is a government program, but it’s not a blank check. And it is not free. Unless your supplemental plan is a Medicaid based plan, where you become “dual eligible”. This where you are eligible for Medicare AND Medicaid. The Medicaid portion can greatly lower co pays and negate deductibles. This is a small portion of American seniors. The vast majority will need to investigate and compare supplemental plans for what fits them best.
Seek out a trusted Independent Insurance Broker. When I mention trusted, I mean those that will review your medical and pharmaceutical needs to find the best match and comfortable financial fit for just you.
Knowing how Parts A, B, and D work, as well as how Medicare Supplements can fill in the gaps gives you the power to make smart decisions and avoid financial surprises.
Jane’s story doesn’t have to be yours! With the right information and coverage, you can protect your health and your wallet and sleep better. Indeed, you have the power and education to protect yourself.
