This might be on-topic because it’s an example of the cost of medical care which affects millions of people. The numbers are the amount that the providers charged Medicare. An uninsured patient would be charged full freight. I have traditional Medicare plus Medigap Part G insurance so I paid only the deductible in 2024 and nothing else.
Background: A nurse practitioner discovered that I had a heart murmur during an unrelated clinic visit on 5/8/24. (My GP never bothered listening to my chest but sat in front of her computer during my visits.) The NP advised me that a heart murmur could be benign…or it could indicate a dangerous problem.
I went to my GP who sent me for an ultrasound. The ultrasound discovered severe stenosis of the aortic valve plus an aneurysm of the ascending aorta. Fast forward… After lots of tests and consults, I had open-heart surgery to replace the aortic valve and ascending aorta. I had a pleural effusion after the surgery and spent 9 days in the hospital. After I came home I wore a cardiac monitor for 2 weeks. I had a cardiac stress test last week (which I passed – YAY!) but the cost isn’t on this list from Medicare.
Medicare was billed $474,098 for all the services (not including the stress test). I actually think this was quite reasonable considering that Medicare was billed $150,000 for my one-night hospital stay including my bilateral mastectomy and reconstruction in 2015.
The surgery and recovery were horrible. I’ve never been so weak in my entire life. (Many thanks to my beloved younger sister and husband who took care of me.)
I’m only just beginning to feel like myself again, 4 months later. I’m glad I had the surgery as soon as I realized I had the problem because I’m not getting any younger. I honestly don’t see how patients who are older and sicker than me could survive this surgery.
My advice is – if you have a heart valve problem get TAVR unless you don’t have a choice. (I needed to get the aneurysm repaired which could only be done surgically.)
For those who are curious, here’s an itemized list.
Date
Item
Provider charged
01/03/25
Cardiac Monitor
$2,495
12/31/24
Blood test
$69
12/18/24
Blood test
$568
12/17/24
Cardiologist visit
$508
12/02/24
Chest X-ray
$35
11/27/24
CT Scan
$250
11/26/24
Chest X-ray
$30
11/25/24
Chest X-ray
$35
11/25/24
ULTRASOUND SCAN OF CHEST
$94
11/23/24
Chest X-ray
$35
11/22/24
Chest X-ray
$30
11/20/24
Chest X-ray
$30
11/19/24 - 11/27/24
Surgery, ICU, hospital stay, lab tests, imaging, physical and occupational therapy, etc.
Because I’m in general good health and had family to take care of me I was able to return home after I was released from the hospital. Many patients have to go into rehab facilities until they are strong enough to take care of themselves. That’s far more expensive in the U.S. than in other countries.
That is great Wendy, and I am glad everything is going great for you but I am just wondering, because there are just so many ways to cut cost, if the government would do that? I mean they are sending prisoners over seas so I could see them sending medicare and medicaid patients out of the country. Not that I would be for it but it’s something to think about. I know the Governor of Montana took a bus load of people up to Canada for their medication and many people along the Mexican border cross over for Dental and medical care.
What was the “Medicare Reimbursement”? That’s the real cost. You’ll find it on the statement your Medigap insurer sends you.
I’d expect the number to be $60,000 or less, with your portion of the $415,544 hospital bill limited to just $1,632 in 2024. The “20% that Medicare doesn’t pay” doesn’t apply to big bills like this.
So if you didn’t have Medigap and went “uninsured” (i.e., just had regular Medicare), maybe your out-of-pocket would be $10,000 or so, probably less. The Medicare reimbursement for a lot of those non-hospital charges (which look to be about $70,000 in total) is probably much less than the prices you’ve listed.
It’s a measure of how much people who don’t have insurance are getting screwed as well. Think of it, those least likely to be able to afford surgery are paying, by far, the most for it. I find that unethical, as a nation.
My valve repair was billed over $500k to insurance, negotiated to under $140k, my out of pocket under $4k. Big-tech benefits.
I’m 69. I’ve been on regular Medicare for 4 years. I can confirm that it’s head & shoulders better than any of the for-profit health plans I had during my career of working for 6 different Fortune 500 companies in the oil & gas and chemical industries between 1977 and 1994.
Yes! That’s what people need to remember about Medicare when they’re evaluating their post age 65 health insurance options. It’s very different from the “unlimited price gouging, for-profit health plan” you had when you were working.
Wendy posted $415,544 Part A hospital charges and an itemized list of $58,240 in Part B non hospital charges.
She owes $1632 for the $415,544 hospital bill and the Medicare Reimbursement for the $58,240 in Part B charges is likely to be 1/2 to 1/3 of what was billed (i.e., $20,000 to $30,000.) Her “20% that Medicare doesn’t pay” should be somewhere between $4,000 to $6000 on that.
I’m guessing about $8,000 tops on $470,000 in medical bills (i.e, 1.7%, NOT 20%).
If you’ve been investing in the S&P 500 over the past 30 years, you can handle that kind of co-pay out of petty cash.
Grandma and the people selling you Medigap and Medicare Advantage plans are leading you astray.
I didn’t present those numbers so this is pure guesswork on your part.
My Medigap Part G insurance is $240 per month ($2,880 per year). I consider this a small price to pay for peace of mind since I have suffered several serious health problems needing expensive care.
Regular Plan G
Regular Medigap Plan G covers:
the hospital deductible
Part A coinsurance
skilled nursing
hospice care
Part B excess charges
Part B coinsurance
With regular Medigap Plan G, a person’s out-of-pocket expenses for Medicare-approved services for the year are the annual Part B deductibles. In 2024, this amount is $240, so as long as a person pays this amount, they have coverage for the entire year. [end quote]
@intercst you may mock my low-risk approach. Go ahead and omit a Medigap plan if you want to. But don’t tell other people how to manage risk.
And, if you happen to have a truly serious, expensive health problem, come and tell us how you are paying your share out of petty cash.
Remember what the poet of TMF, trenchrat said when he got cancer. “Your money melts away like ice cream on a Florida sidewalk.”
trenchrat obviously suffered financially as well as physically.
But maybe he wasn’t as rich (or arrogant) as you are, @intercst.
Add ignorance/lack of imagination to that rap sheet. Oftentimes, the one off, out of the blue surprise you (I, my husband and maybe a few others here) received in spite of good custodianship of their bodies ends up being the proverbial canary in the coal mine in a sharp nosedive in health…and concurrent increase in expenditure.
My additional advice…if you’re someone who has regular annual physicals/wellness checks or whatever the nomenclature, make sure your PCP nails the simple stuff. The fundamentals that pick up honkin’ big Red Flags that, if noted early, might well avoid big problems later on…or at least allow for a choice and possibly provide for long term better outcomes. I was amazed when, during casual conversation a few visits ago…and a bit before your problem was diagnosed, Wendy…our GP mentioned that, as incongruous as it may sound, Medicare reimbursement for the “wellness check” for us Real Grown Ups doesn’t include the laying on of stethoscope…at a time in a person’s life when it was probably most worthwhile as a screening tool. We (all 4 of us…dh, me, doc and the scribe) spent a few more minutes discussing the nitwittery of that, but assumed that most every doc probably just went ahead and did it anyway …gratis… as the appropriate thing to do (just like I gave a local anaesthetic for every restorative proceedure/extraction even though insurance reimbursement didn’t provide for that specifically)
Supervised neglect this sort of thing is called…or, as I call it, the Curse of the Good Custodian. The appearance of healthy lifestyle choices in patients can lead to a bit too much complacency in healthcare providers these days when so many on their books demonstrate the opposite.
Not at all. $1,632 is the Medicare Reimbursement for the $415,000 hospital bill, and the $58,000 in Part B charges are typically double or triple the Medicare Reimbursement.
It just a matter of doing your research, understanding the numbers. and being aware of how Medicare is very different from the health insurance policies you are accustomed to..
I’d be surprised if my $8,000 estimate is off by more than $1,000.
Wendy: “My Medigap Part G insurance is $240 per month ($2,880 per year). I consider this a small price to pay for peace of mind since I have suffered several serious health problems needing expensive care.”
Right. Your “several serious health problems needing expensive care.” happened pre-age-65 under the unlimited price gouging health system. Don’t let that experience color how you approach Medicare. It’s just going to cost you extra insurance premiums you don’t need to pay.