Social Security & Medicare Questions - February 2012

Social Security & Medicare Questions – February 2012

Why Is My Mother’s Co-Pay So High This Year?

Q: My mother moved to live closer to me a few months ago. Recently, she needed to visit a doctor and was charged $116. She can’t remember ever paying so much before. Her old check registers show co-pays of about $20. Are these new changes to Medicare?

A: The charges you describe sound like one of two causes — either your mother is satisfying her annual Part B deductible, or she moved outside of her former Medicare Advantage plan’s service area, and the charges may not be covered at all, because she needs to enroll in a new plan. Either way it’s important to determine the cause and take appropriate action, if necessary. It’s important for both of you to determine whether she has a Medicare supplemental (Medigap) plan, or gets her Medicare benefits through a Medicare Advantage plan.

If your mother has Medicare supplemental (Medigap) coverage the charge may be due to satisfying the Part B deductible, which is $140 in 2012 and tends to rise annually. Only two of the ten standard Medigap plans cover the entire Part B deductible — plans “C” and “F.” Plan “N” pays 100% of the Part B coinsurance, EXCEPT for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission. If your mother is enrolled in plan “A,” “B,” “D,” “G,” “K,” “L,” or “M,” that may account for the $116 charge.

If your mother is enrolled in a Medicare Advantage plan her plan may not serve the area in which you live and where she was charged the full cost of the visit. It’s important to call her plan to tell them she has moved and to find out if they have similar plans serving your area. Otherwise you need to move quickly to enroll her in a new plan. You can learn about and compare the health plans available in your area on the Medicare website at and use the “Compare Drug and Health Plan” tool. The screens will ask for the zip code where your mother lives, and you will be able to enter the prescription drugs she will need coverage for.

If you would like to get help for the enrollment process, you can get free, unbiased counseling through your State Health Insurance Assistance Program (SHIP), many of which operate through local Area Agencies on Aging. Check the number in your local phone book. For more information, see the publication: Medicare & You 2012.