Get Help Managing Out-of-Pocket Medicare CostsPosted by Medicare Made Clear
Medicare doesn’t pay 100% of your health care costs. In general, you are responsible for:
- A monthly Part B premium (Part A is premium free for most people)
- An annual Part B deductible
- 20% of the Medicare-approved amount for outpatient services covered by Part B, such as doctor visits
- Deductibles, coinsurance or copayments when you receive inpatient services covered by Part A
- Prescription drug costs
Luckily, there are two ways you could get help.
1. Add Medicare Supplement Insurance and a Part D plan
Medicare supplement insurance is supplemental coverage that you can add to Original Medicare Parts A and B. Plans are offered by private insurance companies.
There are a variety of Medicare supplement plans available. The basic benefits provided by each plan are standardized by the federal government. Medicare supplement plans help pay some of the out-of-pocket costs not paid by Medicare Parts A and B, except for prescription drugs.
Medicare supplement plan availability and costs may vary depending on where you live. In Massachusetts, Minnesota and Wisconsin, plans are standardized in a different way from those offered in other states.
You may choose to buy a Medicare Part D prescription drug plan in addition to a Medicare supplement plan to help complete your coverage. Part D plans are also offered by private insurance companies.
Each Medicare supplement plan and Part D plan charges a monthly premium. You may also have co-pays or other out-of-pockets costs depending on your specific plan choices. It pays to shop around, since costs can vary widely, even for exactly the same coverage.
2. Choose a Medicare Advantage Plan
Medicare Advantage (Part C) is an alternative to Original Medicare Parts A and B. It’s a different way to get your Medicare benefits.
Medicare Advantage plans are offered by private insurance companies. By law, every plan must include all the benefits provided by Parts A and B. Plans may offer additional benefits, but they must at least meet the minimum standards set by Medicare.
You may be able to get all your coverage in a single Medicare Advantage plan, much like employer plans you may have while working. Many plans include prescription drug coverage. Some plans offer routine dental, vision and hearing care as well.
Coverage and costs are set by each plan. In general, you pay a small co-pay for the health care services you use. Also, Medicare Advantage plans are required to place a cap on the out-of-pocket costs you might have to pay in a year. There is no cap with Original Medicare.
Look for plans available in your area and take the time to shop around.
What Will You Choose?
There is no right or wrong when it comes to Medicare and Medicare-related insurance. You need to choose based on your needs and on the plans that are available where you live.
From a cost perspective, you may want to review your choices and compare costs in two “buckets.” For each choice, look at total monthly premiums in one bucket and other out-of-pocket costs (deductibles, co-pays or coinsurance) in another. Usually, when costs in one bucket go up, costs in the other go down.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048