How to plan for healthcare costs not covered by Medicare

There are two parts to the Original Medicare plan — Part A (hospital care) and Part B (medical care). As you plan for retirement and determine what type of coverage you’ll need, it’s important to know that the Original Medicare plan is robust, and it covers many different services. But Medicare might not cover all your health care needs. And keep in mind that coverage varies by state.

Medicare generally doesn’t cover hearing, dental, vision, or routine foot care. It also doesn’t cover elective surgery that isn’t considered medically necessary, like cosmetic surgery. Importantly, Medicare also doesn’t cover most prescription drugs. You can use a Medicare Advantage plan to cover prescriptions or purchase a standalone prescription drug plan, called Medicare Part D. These prescription drug plans are usually offered through private companies, like Leon Health.

The costs of long-term care should also be considered when planning for out-of-pocket medical expenses.

Medicare Part A Out-of-Pocket Expenses

Most people won’t have to pay a monthly premium for Medicare Part A. However, there are other costs associated with Part A. It’s important to consider what services you may need so you can plan. Additional cost may include:

  • A $1,484 annual deductible for inpatient hospital stays.
  • A $371 per day coinsurance for hospital stays between 61 and 90 days.
  • A $742 per day coinsurance for each “lifetime reserve day” after day 90 in the hospital. After you reach the 60-day limit of lifetime reserve days, Part A will not cover any hospital costs.
  • A 20% copay for durable medical equipment.
  • A 20% copay for mental health services you receive while in the hospital.
  • A $176 per day coinsurance for skilled nursing facility stays between 21 and 100 days. After day 100, Part A won’t cover any costs.
  • If you do have to pay a monthly premium for Part A because of your work history, you may pay up to $471 per month.

Medicare Part B Out-of-Pocket Expenses

Medicare Part B covers medical services, ambulance services, clinical trials, durable medical equipment (crutches, walkers, wheelchairs, blood sugar monitors, and oxygen equipment), mental health services, and urgent care. Part B also has a monthly premium, deductibles, and copays. These additional costs can include:

  • A $203 annual deductible.
  • A 20% copay after you meet the annual deductible. This means you will pay 20% of the Medicare-approved amount for most doctor services, treatments, outpatient therapy, and durable medical equipment.

Medicare Advantage Plans Out-of-Pocket Expenses

Medicare Advantage plans are private insurance plans. These plans cover all the services offered as part of Original Medicare, except hospice care. Each Medicare Advantage plan is different, and coverage and costs can vary.

Medicare Part D Out-of-Pocket Expenses

Medicare Part D is a prescription drug plan. Since Original Medicare doesn’t cover most prescription drugs, you may consider a Part D plan if you want to avoid high out-of-pocket costs for medications. These plans are offered through private insurance companies. Premiums, copays, and deductibles can vary across plans, as well as the types of medications that are covered.

Next Steps

If you’re interested in learning whether Medicare is right for you, we’re ready to help. Are you ready to talk to one of our specialists about Medicare plans? Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.

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As you prepare for Medicare, you’ll be faced with many important decisions. LEON Health wants to help you select the best options for your needs.

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