Traps Within Medicare - 2019 Edition : How to Spot Them, How to Avoid Them, and How to Optimize Your Healthcare at the Lowest Possible Cost

Medicare is a maze of pitfalls, traps and consequences wrapped in strange language and acronyms. Words often have quite different meanings than simple English would make us think. A normal human can easily reach very different conclusions after a discussion or research session, than that which is correct.A simple example: the word covered. When we're told that a procedure or treatment or visit is covered by Medicare, our normal English interpretation is that our costs are taken care of, is it not?This is not the case, not by a long shot. Covered, to the folks at Medicare, means that they will pay some part of the cost, leaving us with sometimes huge out-of-pocket expenses. And figuring out what part they will pay can be far from simple.To illustrate, let's consider medical bills "covered" under Part B of Medicare, the part that encompasses doctors' bills and outpatient treatments, for a common senior procedure -- a knee replacement. Most of these are now done in outpatient surgery centers; your doctor will say, and Medicare will confirm, that an outpatient knee replacement is covered by Part B. If you merely accept that language as plain English and assume that you can have the procedure without cost, you are in for a massive set of surprises.Covered under Part B means, at best, 80% of the costs are actually covered by Medicare payments. You pay a monthly premium of $135.50 in 2019 for Part B coverage. Then you pay a deductible, $185.00 in 2019, upon your first use of Part B benefits in the calendar year. But the biggest surprise of all is that you have to pay 20% "co-insurance" for all Part B charges -- plus an additional (up to) 15% for "excess charges" if your doctor elects to bill you for more than Medicare will pay.Let's run the numbers. Costs for a knee replacement will vary widely with doctors, facilities, and your specific condition and complications. To get into the ballpark, we looked at some reputable websites for data. Howmuchisit.org quotes a range of $40,000 to $80,000, all-in. Healthline.com estimates the average cost at $57,000. These amounts do not include the extensive after-care required, including a lot of physical therapy, also covered by Part B. If nursing home or in-home health care is required for you, these charges may or may NOT be covered, but that's a subject for another discussion.We will be very optimistic and estimate that your final tally of bills comes to $60,000, and are entirely covered by Part B. So before you get to skip on home from the outpatient center with your new knee, you will have to lighten your wallet by at least $12,185. Assuming there are no complications. If the doc thinks his work is worth billing you excess charges, add many thousands more. Is that a check you can afford to write, or will you have to grind about painfully on your old knee for the extra years it might take to accumulate that much cash?This book will guide you over, under, around or through all of the traps lying in wait for you within the Medicare maze. In a short 2 or 3 hour read, you will gain an education about the problems and the solutions within the systems that many professionals struggle to comprehend. You will become a truly informed consumer, prepared to grapple with your own set of constraints as you pass the milestone of "Happy 65th!"Decisions you make at this critical time, when most new seniors are totally unprepared for the complexities ahead, will either help you or hurt you for many years to come. Many are irrevocable. The solutions are affordable and relatively painless, for the well-informed. Read this book and join their ranks.


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Rick Mortimer is an aging Baby Boomer living in the beautiful foothills of the North Carolina Piedmont. When he hit the 65-year mark, he began his personal journey through the maze of everything Medicare. He was dismayed by the complexity of the decisions that had to be made, the lack of available strategies for making them, and the convolutions of the system in place to provide this vital set of services to over 60 million Americans.

First licensed to sell insurance in 1988, and working as a trust advisor for many years, he knew his way around the industry and the terminology very well. Even with this background, he found the process so daunting and confusing that he decided to come out of medically induced retirement and get re-licensed, so that he could help others facing the wall of questions that Medicare generates. Coming from a career centered on entrepreneurship, this move quickly led to the founding of Next Mountain Advisors Inc., a firm established to help fellow seniors navigate the changing requirements of living with an aging body, and a fixed or declining set of resources. In its first year, the firm hired and trained agents in several states, ranging from New Jersey to Michigan, and from Colorado to California

Mortimer has seen the inside of the healthcare system as a too-often patient, surviving the challenges of prostate cancer and proton beam therapy, congestive heart failure and A-fib, near death after a stenting procedure, multiple ablations and other heart procedures, a deep staph infection caused by knee surgery, and a diagnosis of Parkinsons disease. His new mission is what keeps him alive, and focused on delivering as much value to others as possible in his remaining years.

He is also the founder of the new American Association of Professional Medicare Agents, at MedicarePros.org, an organization dedicated to supporting and codifying the practice of impartially and thoroughly educating seniors on the decisions they face, and helping them get the products and services they need.

He works personally with clients all over North Carolina, and is available to speak at senior-focused events anywhere in the country. He can be reached at

rick@NextMountainAdvisors.com
Toll free: (866) 468-9086

And he encourages his readers to not be shy or intimidated – but to pick up the phone and call with any questions or suggestions!