Louisiana Senior Advisors

Understanding Surprise Medical Bills

2026-07-08

HAMMOND, LA — Imagine doing everything right. You check your insurance, choose an in-network facility for a scheduled surgery, and believe your finances are safe. But weeks later, a massive bill arrives. The facility itself was in-network, but the specific anesthesiologist who put you under, or the pathologist who read your lab tests, was out-of-network.

This stressful situation is called surprise billing. It happens when an out-of-network doctor treats you at an in-network facility. Because the facility is approved, your insurance pays its standard, contracted rate. However, because that specific doctor doesn't work with your insurance, they may bill you directly for the leftover difference between their total charge and what your insurance covered. This extra charge is called balance billing.

If you have an HMO, which usually covers zero out-of-network care, the doctor may even bill you for 100% of their fees. Fortunately, both federal and Louisiana laws have addressed this practice. The law protects you from being penalized for their network status.

Under the federal No Surprises Act, out-of-network specialists are banned from balance billing you for non-emergency care at an in-network hospital or surgery center. They must work it out with your insurer, and you should only owe your normal, in-network copay or deductible.

On top of that, the Louisiana Balance Billing Disclosure Act (RS 22:1880) requires facilities to give you a clear, written warning before your procedure if an out-of-network doctor might be involved. If they fail to give you this notice beforehand, they may be legally barred from collecting those extra charges.

Furthermore, the federal One Big Beautiful Bill Act of 2025, signed into law on July 4, 2025, requires hospitals to bundle all the charges from different doctors into a single, easy-to-read statement for your treatment. This means you will not get a confusing stream of separate bills arriving in your mailbox weeks after you leave the hospital.

While these legal shields are robust, local patients should be aware of a few critical exceptions where surprise costs can still occur.

First, you may be asked to give up your rights during the check-in process. Facilities often hand patients a thick stack of paperwork that may include a “consent to waive protections” form. If you sign it, you voluntarily waive your legal safeguards and can be balance billed.

Another exception involves ground ambulances, which are only fully protected during emergencies. If you require a non-emergency transfer between healthcare facilities, you can still face an unexpected balance bill for that ride.

If you used an in-network facility and an out-of-network doctor sends you an independent bill, review it carefully before you pay it.

Make sure the claim has been filed properly with your insurance company.
Check your insurance company’s Explanation of Benefits (EOB) to see what you actually owe.
If the doctor's bill is higher than your in-network rate, call the provider and your insurer immediately to discuss the charges.
If there are discrepancies, inform the provider that you are formally disputing the bill.

Formally disputing the bill triggers consumer debt protection, which temporarily freezes collection efforts and protects your credit while the mistake is corrected.

Healthcare laws can be very complex and can vary in each individual situation. For specific guidance regarding your legal rights and consumer protections as it relates to surprise billing, please consult with a qualified legal advisor.

If you or a loved one need a hand at making sense of your coverage, checking networks, or choosing a policy that protects your hard-earned savings from unexpected medical bills, come chat with us at Louisiana Senior Advisors in Ponchatoula.

We love helping our neighbors! We are LOCAL! At Louisiana Senior Advisors — We Make Insurance Easy!

Tonya Aiken, Owner
Louisiana Senior Advisors, LLC

Medicare’s IRMAA in 2026: The Extra Charge Some Retirees Don’t See Coming

2026-02-03

If you’re on Medicare—or about to be—you may have heard people grumbling about something called IRMAA. It sounds intimidating, but the idea behind it is pretty simple.

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s an extra charge added to your Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums if your income is above certain levels. The catch? Medicare looks at your income from two years ago to decide what you’ll pay today.

So for 2026, Medicare uses your 2024 tax return to determine whether you owe an IRMAA surcharge.

Most people with Medicare pay only the standard premiums. But if your modified adjusted gross income (MAGI) was more than $109,000 for an individual or $218,000 for a married couple filing jointly, IRMAA may apply.

2026 Medicare Part B & Part D IRMAA Chart

2024 Income (MAGI)	Part B Premium (2026)	Monthly Part D IRMAA
≤ $109,000 (individual) ≤ $218,000 (joint)	$202.90 Standard Premium	$0 + plan premium
$109k–$137k / $218k–$274k	$284.10	$14.50 + plan premium
$137k–$171k / $274k–$342k	$405.80	$37.50 + plan premium
$171k–$205k / $342k–$410k	$527.50	$60.40 + plan premium
$205k–$500k / $410k–$750k	$649.20	$83.30 + plan premium
≥ $500k / ≥ $750k	$689.90	$91.00 + plan premium

Note:

The Part B amount already includes the standard $202.90 premium.
The Part D amount is added to whatever premium your drug plan charges.

A Real-Life Example

Let’s say Mary, a retired teacher, earned $145,000 in 2024 due to a pension, Social Security, and a one-time IRA withdrawal.

In 2026, Mary falls into the $137,000–$171,000 IRMAA bracket, which means:

Her Part B premium jumps from $202.90 to $405.80 per month
She also pays an extra $37.50 per month on top of her Part D drug plan premium

That’s an additional $240 per month, or nearly $2,900 a year, compared to someone paying only the standard Medicare premiums.

And here’s the part that surprises many retirees: even if Mary’s income drops in 2026, Medicare will still charge IRMAA unless she files an appeal showing a life-changing event like retirement, loss of income, divorce, or death of a spouse.

Why This Matters

IRMAA affects only about 8% of Medicare beneficiaries, but those who are impacted often don’t see it coming—especially during the early retirement years when required minimum distributions, home sales, or investment income can spike taxable income.

The good news? With the right planning—and the right guidance—many people can reduce or even avoid IRMAA surprises. You may be able to appeal using form SSA-44 if you’ve retired or had a major income change. But you must do so within 60 days upon receiving notice from Social Security. Contact our office or your local financial advisor for more information.

Tonya Aiken

“We Make Insurance Easy”

Louisiana Senior Advisors, llc

Medicare Premium Costs Are Going Up in 2024. Here's How Much

2023-09-25

It's projected that Medicare Part B premiums will be more expensive in 2024, but Part D should be slightly cheaper.