Medicare Part B: your share of doctor’s bills goes on and on

My friend’s mother gets health coverage from Medicare.  She has a lot of health issues but had been in fairly good health until recently when she took a turn for the worse.  She has frequent doctor’s appointments for her various ailments – diabetes, high blood pressure, arthritis.  Though Medicare pays most of these bills, she is left to pay her share – which is now a significant chunk of her retirement income.  What can she do? Are there other plans that she could join that would make her pay less toward her medical bills?  When we last visited her, I noticed that her refrigerator was almost empty.  I hate to see her become one of those older people who cannot afford groceries.

Trying to Help

Dear Trying to Help,

She has discovered the limits of Medicare: her 20 percent share of her doctor’s bills goes on without end.  Medicare has no “maximum out of pocket”.  That is, there is no dollar limit to how much she will pay for her share of her physician bills, covered under what is called “Medicare Part B”.

A plan called “Medigap” or “Medicare Supplement” would help her by putting a cap on her share of her medical bills.  She can buy one of these plans within six months of the month she turned 65 or the month she enrolled in Medicare Part B.  If the six months has gone by, she can still apply for a plan but an insurer can refuse to cover her or can charge her more.  To find the plans available to her, go to Medicare’s Medigap Policy Comparison Tool.

If her income is low and she has few assets (aside from the home she lives in), she may qualify for Medicaid.  Medicaid would, in essence, become her “Medigap” policy and pay for her share of her medical bills.  She may also qualify to have Medicaid pay her monthly Medicare Part B premiums.  You can start by filling out an application for Medicaid; the applications for Medicaid and other public assistance programs are available online.  There may be other assistance that she qualifies for to help her buy food.  The website will guide you through the steps to contact your local Health and Human Services office.


Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.