Advisor Perspectives welcomes guest contributions. The views presented here do not necessarily represent those of Advisor Perspectives.

Here’s a common conversation I have with my Medicare-aged clients – who are typically also clients of a financial advisor.

“I went to my doctor’s visit and they told me that the shingles vaccination isn’t covered by Medicare?”

Me: “That’s correct. The coverage falls under your drug coverage, the Part D plan. But, expect to pay approximately $175 for the shot. Yes, for each of the two shots – the first one, then the booster.”

That right there is what most of us would consider a “surprise” expense related to Medicare and health insurance, right?

Try this one on. We’ve met Medicare eligible people that have had to pay $30,000 for plane rides to be emergency evacuated to home from outside of the United States when extremely ill.

That’s another surprise medical expense.

Let’s talk about a few large “surprise” Medicare-related expenses that your clients may not know about:

1. IRMAA. This is the Income Related Monthly Adjustment Amount assessed by Medicare for high income earners.

This is definitely the most common “surprise” expense. It’s amazing how many people approaching Medicare age feel that Medicare health insurance is free or at least highly subsidized. When I ask, “Do you know how much you’ll be paying for your Part B premium?” I rarely get a “yes.”

I have a new client who is a physician. He and his wife are newbies to Medicare, how it works and how much it costs. He called me recently in a foul mood saying, “I am paying close to $20,000 a year for this health insurance?” My response? “Yes, you are.”

Surprise. You can help your clients many years prior to Medicare eligibility by discussing with them the impact of the number on the modified adjusted gross income line on their tax returns. That line determines how much their Medicare Part B will cost. Don’t let them be shocked and upset when they learn it from us.