How to Avoid Unexpected Medical Bills on Medicare

A DOWN-TO-EARTH GUIDE TO PROTECTING YOUR WALLET AND GETTING THE CARE YOU NEED WITHOUT BILLING SURPRISES.

Whether you’re brand new to Medicare or have been on it for a while, this one thing’s for sure: You can’t afford to let your guard down when it comes to medical bills.

I know it can feel confusing, and also tedious to check into these things.   But being your own advocate is more important than ever, especially as more doctors join large corporate medical groups. This makes it harder to get a real person on the phone when a billing issue pops up.

All the points I'm about to make will apply to you whether you're on Original Medicare with a Medigap plan, or a Medicare Advantage plan.

Step 1: Double-Check What Medicare Sees

Go to Medicare.gov and create your account (if you haven’t already). You want to make sure the correct secondary insurance is listed.

One of the most common billing issues: Medicare could have old group plan still listed as your secondary insurance even though you’ve already moved onto a Medigap or Advantage plan.

This little mistake can major problems because it will appear as if your medical bills aren't being covered. If you notice a problem with the wrong "secondary" insurance listed,  contact the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627. 

Step 2: Understand Preventive Visits and Deductibles

If you have Original Medicare and a Medigap plan, there’s an upfront Part B deductible of $257 (in 2025). Here’s where people get tripped up:

Let’s say you go in for your Annual Wellness Visit. You expect it to be free. But your doctor recommends lab work or screenings not covered under that “free” visit.

On Original Medicare (plus a Plan G, for instance), these extra tests might not be free unless your deductible is already met. That’s a common reason people get a bill they didn’t expect.

• Tip: Ask your doctor’s office up front if everything they’re recommending is covered by Medicare under preventive care or if there could be an out-of-pocket cost. 

On the other hand, Medicare Advantage plans usually offer $0 copays for primary care visits and often don’t have an upfront medical deductible.  But on rare occasions some do, especially for things like CT scans, MRIs, surgeries, injections, or infusions.  Check your summary of benefits to be sure!

Check your Summary of Benefits or Evidence of Coverage booklet to see exactly what’s covered for ANY service, in advance, and so you know what to expect.  Also,  for any service you can ask your doctor's billing staff to give you estimated costs up front. 

Step 3: Know What a Deductible Actually Is

A lot of people confuse deductibles with copays, but they’re not the same.

Your deductible is the amount you pay out of pocket before your insurance kicks in.

So if you haven’t met your deductible yet, several early-in-the-year appointments close together can lead to several bills.  You may not know if they are accurate, until checking which went toward the deductible.  Here’s the kicker: the bills don’t always come in order of your appointments. That's why confusing to figure out which bills have actually been applied toward your deductible.

• Tip: Wait before paying your bills. Let claims process through Medicare first, and use your Medicare.gov account to track what’s been applied toward your deductible.

Step 4: Always Ask for Costs Up Front



If you remember nothing else, remember this:

Doctors’ offices are required to inform you if something isn’t covered by Medicare.  But you may have to be pro-active about this to find out for sure.  (Don't forget, you have to be your own advocate)!   Even though they should be informing you what's covered by Medicare and what isn't,  you can't rely on them to do it, so you must make sure you find out in advance.

This is especially important if:

• The doctor might not be in-network for your Advantage Plan
• You need pre-authorization for a procedure
• You’re on Plan N (which may allow up to 15% in excess charges if the doctor doesn’t accept assignment)

Step 5: Be Skeptical of Every Medical Bill

If a bill shows up in your mailbox, don’t assume it’s right.

Get into the mindset that bills are more likely to be wrong than right.  I know that sounds cynical, but it's better than overpaying by mistake.

Before paying, find out:

• Was the claim submitted yet?
• Has Medicare or your plan processed the bill?
• Is the amount correct?
• Could the procedure have been coded incorrectly?

Coding mistakes happen all the time.  A preventive colonoscopy might get billed as diagnostic. The “Welcome to Medicare” visit might be coded wrong. These small errors can cause bills to be sent that are in error. 

• Tip: If you're my client, I’ll help you troubleshoot billing issues like these. Don’t pay a bill until you know it’s accurate.



Step 6: Avoid Drug Cost Surprises

Drug costs through your Part D can be unexpectedly high when you go to pick them up at the pharmacy.

Maybe your prescription was written for a capsule instead of a tablet. Maybe the pharmacy isn’t preferred. Maybe a prior authorization is missing.  Don't just assume the cost they quote you is your ONLY option and you must pay it. 

• Tip: Call the pharmacy before picking up your medication to get the price. That gives you time to catch mistakes and make adjustments.



Some helpful tools and options:

• GoodRx or other discount coupons.
• CostPlusDrugs.com or Canadian pharmacies.
• Monthly payment plan for expensive drugs (available through your drug plan).

Let’s Recap

Here's a "to do" list to stay ahead of billing mistakes:

• Make sure your secondary insurance is listed correctly on Medicare.gov (mainly for those "new-to-medicare").
• Know your deductible and how your plan type works.
• Understand what’s actually covered under preventive visits.
• Always ask for cost estimates in advance.
• Be skeptical of every bill and verify its accuracy.
• Double-check drug prices before heading to the pharmacy.

These simple steps can go a long way to prevent billing issues.

Want Support Along the Way?

If you want someone in your corner, I’m here to help. I’m Pam Turner, and I help Medicare eligibles confidently choose and manage their coverage without pressure, and at no cost to you.

You can use me as your broker when you’re first signing up for Medicare. Or, if you're already enrolled, I can help you switch to a lower Medigap rate (if you qualify) or explore changes to your Advantage Plan especially during certain windows like Open Enrollment or the one-time Advantage Plan switch (ending March 31).

Let’s make sure your plan fits your needs and your budget.

Reach out if you’d like to explore your options.



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