Medicare Doesn’t Cover Everything

I enjoy meeting with people who are new to Medicare. They have worked and paid taxes for many years and for many they are excited for the best insurance they have ever had. However, they are often surprised to find out that they have to pay a premium for Part B of Medicare, and there are things that Medicare does not cover.

What is your out-of-pocket cost?
Part A (hospital insurance) - Most people do not pay a premium for Part A of Medicare as long as they or a spouse has worked and paid taxes. There is a deductible of $1,484 associated with Part A, and you may have to pay this deductible more than one time during a calendar year. After the deductible, there is a daily copayment for hospitalizations that last longer than 60 days and for Medicare-approved skilled nursing stays longer than 20 days.

Part B (outpatient insurance) - There is a monthly premium of $148.50 in 2021 for Part B of Medicare. The deductible is $203 in 2021. Once you pay the deductible then Medicare will pay 80% of the charges. You are left with the remaining 20% with no out-of-pocket limit.

Medicare supplement plans and Medicare Advantage Plans can help to limit your out-of-pocket expenses associated with Parts A & B of Medicare.

Services not covered by Medicare - as found on page 51 of your Medicare and You handbook
Long term care
Skilled nursing that does not follow a three-day hospitalization
Dental care and dentures
Eye exams for prescription glasses/glasses/contact lenses
Cosmetic surgery
Massage therapy
Routine physical exams
Hearing aids and exams for fitting them
Concierge care
Covered items or services from an opt-out provider except in the case of an emergency
Care received while traveling outside of the United States
Routine foot care
Prescription medications

It is important to understand the limitations of Medicare and the plans designed to fill in the gaps so that you are not surprised when you receive a bill. I am always happy to help you understand your options.