She skipped Medicare Part B to save money. Now her family faces a massive bill : Shots - Health News A frugal Tennessee resident opted out of Medicare Part B, which carries $175 monthly premiums. Now her heirs face a huge bill for an air-ambulance ride.

Her air-ambulance ride wasn't covered by Medicare. It will cost her family $81,739

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MICHEL MARTIN, BYLINE: And now it's time for our February Bill of the Month. Dr. Elisabeth Rosenthal is senior contributing editor with our partner, KFF Health News. Welcome, doctor. Welcome back.

ELIZABETH ROSENTHAL: Good to be back.

MARTIN: So whose bill are we discussing today?

ROSENTHAL: We're looking into a bill for Debra Prichard. Debra had a stroke and several brain aneurysms last year. After one incident, though, Debra was rushed by helicopter from rural Tennessee to a hospital in Nashville. Debra, who was 70, died of a brain bleed some weeks later. That left her family to deal with the financial fallout from the air ambulance trip.

MARTIN: OK. Reporter Emily Siner spoke with Debra's daughter, and now Emily has a breakdown on the ins and outs of Medicare like nothing you've heard before.

EMILY SINER, BYLINE: Alicia Wieberg's mother, Debra, was a retired factory worker who was careful with her money, loved her grandkids and was a very private person - sometimes to a fault, Alicia says.

ALICIA WIEBERG: Anytime we tried to get her to talk about having a will or if she had enough money, or if she had enough insurance, she just always was very tight-lipped about it and said everything was fine.

SINER: This was a problem after Debra's emergency flight to the hospital. Shortly after her death, the family opened up a bill from the helicopter company for nearly $82,000. Alicia had heard that helicopter bills could be expensive, but that price tag left her stunned.

WIEBERG: We had already kind of done an internet search to see what the average price would be. But then when it came in, we were just kind of like, this is ridiculous.

SINER: At the heart of the issue is the complicated nature of Medicare. Most Americans age 65 and older can enroll for free in what's called Medicare Part A, and this covers hospital stays, like Debra's. But what it doesn't cover is ambulance rides. For that, you need Medicare Part B, and Part B costs about $175 a month if you don't have a subsidy. Alicia realized after the fact that her mother skipped that coverage. She suspects Debra wanted to avoid having to pay for those premiums every month.

WIEBERG: I just wish I had known she didn't have adequate insurance so that I could have talked to her. And whether it would have done any good or not, it would have still felt like I did what I could.

SINER: To make things more confusing, in addition to Part A and Part B, Medicare also has a Part C and D. And so while Alicia is frustrated that her mom did not get the extra insurance, she's also frustrated by the Medicare system.

WIEBERG: I do find it concerning that, you know, seniors on a fixed income have to make that decision. Why - as you get older and you go into Medicare and fixed incomes, why is it more complicated?

SINER: As for the lingering bill, a spokesperson for the helicopter company, Global Medical Response, said in an email it's committed to finding a, quote, "equitable solution." Alicia has been working with the lawyer for her mother's estate, who tried to get the medical transport company to negotiate on the cost. As of early February, Alicia says the company had not offered to reduce the bill.

WIEBERG: And they said that they would wait to see what the inventory of the estate was.

SINER: In the meantime, Alicia is trying to sell her mother's longtime home and property. As it stands, if the family ends up having to pay the nearly $82,000 bill, that single helicopter ride could eat up about a third of the estate's value.

For NPR News, I'm Emily Siner.

MARTIN: And now we're back with Dr. Elizabeth Rosenthal. Doctor, for Bill of the Month, we've talked about pricey air ambulance rides before. So that part - it's disturbing, but it's not new. But weren't there changes to help patients avoid these surprise bills?

ROSENTHAL: Well, first, let me share an update on this particular bill. This month, the helicopter ambulance company filed in court to collect the entire bill from Debra's estate. That's nearly $82,000. But you're right. The federal law called the No Surprises Act does a lot to protect patients from outrageous air ambulance bills, but it only covers patients with commercial insurance.

MARTIN: OK, but Debra had public insurance, so why wasn't she protected?

ROSENTHAL: Well, it didn't seem necessary for public insurance like Medicare or Medicaid to be included in that law since the government sets rates that are much lower than what companies typically charge. But that only works for Medicare if you understand those ABCs - the complicated stuff. And remember, Debra didn't pay for Part B, which covers ambulances. We spoke with one health economist who says if Debra had Part B, the maximum charge Medicare would have allowed would have been less than $10,000, and the patient portion may have been less than $2,000 - so a big difference there.

MARTIN: Can we expect to hear about other sky-high air ambulance bills?

ROSENTHAL: Sure, because the No Surprises Act offers a lot of protection, but it's not airtight. This is especially important for people who are uninsured or on high-deductible plans. Also, if they live in a rural area like Debra Prichard, you have to be especially mindful since you're much more likely to need a so-called life flight, particularly as more rural hospitals close.

MARTIN: That is Dr. Elisabeth Rosenthal. Dr. Rosenthal, thank you so much.

ROSENTHAL: Thanks for having me.

MARTIN: If you have a confusing or outrageous medical bill that you want us to review, please go to NPR's Shots blog and tell us all about it.

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