What Medicare Doesn’t Cover: A Look at Some of the Most Common Out-of-Pocket Expenses

When you turn 65 and enroll in Medicare, you might find that you need to adjust to Medicare after having private insurance. But you’ll most likely be pleased with the switch! With that being said, though, there are things that Medicare doesn’t cover, meaning you’ll have some out-of-pocket expenses to budget for, as you would with a private health insurance plan. Some of these expenses change every year; it’s important to be up-to-date so you can plan for them, as well as know what type of Medicare Supplement Plan will help keep your out-of-pocket expenses to a minimum.

Medicare Out of Pocket Costs

hundred dollar bills floating around
You will have some Medicare out-of-pocket expenses, which is important to know so you can prepare and budget for them.

Medicare Part A Costs

Medicare Part A is hospital insurance, which covers most inpatient hospital services. Most people don’t pay a Part A premium, because this is covered by the Medicare taxes you have paid while working. But if you don’t qualify for free Medicare Part A premiums, you will have to pay up to $499 each month for hospital insurance.

For Medicare Part A, your biggest out-of-pocket expense is your annual deductible, which you will have to meet if you are admitted to the hospital. For 2022, the Part A annual deductible is $1,556, and covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. If you go over 60 days, you’ll have to pay a coinsurance of $389 per day for the 61st through 90th day of hospitalization in a benefit period, and $778 per day for lifetime reserve days. If you need a skilled nursing facility, your daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022.

Medicare Part B Costs

Medicare Part B covers outpatient medical services, including durable medical equipment. There are a few more out-of-pocket expenses for Part B than there are for Part A: you will have to pay a monthly premium, coinsurance, and meet your annual deductible. Each year, these costs change slightly. For 2022, the standard monthly premium for Medicare Part B enrollees is $170.10, the annual deductible is $233, and coinsurance will remain at 20% of the Medicare billable amount of services.

What Medicare Typically Doesn’t Cover

In addition to the out-of-pocket expenses associated with Medicare Parts A and B, there are other things that Original Medicare does not cover, including: dentist with a light on his head.

  • Most dental care, including dentures and dental implants
  • Most vision care, including eye exams for glasses and contacts
  • Most hearing care, including hearing aids, exams, and fittings for hearing aids
  • Long-term or custodial care
  • Most cosmetic surgery
  • Massage therapy and acupuncture
  • Routine foot care
  • Personal comfort items and services
  • Medical expenses outside the U.S.
  • Prescription medications

Medicare also will not pay for services and supplies that your doctors consider medically unnecessary.

Extra Coverage

As we pointed out above, Medicare Part B will only cover the cost of services or treatment at 80%, leaving you to pay the other 20% out-of-pocket. If you need to have major surgery, like a heart transplant, this can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan. 

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Preparing For Medicare Open Enrollment: 2021 Medicare Costs

The Centers for Medicare & Medicaid Services (CMS) has finally released Medicare costs for 2021. Knowing these costs will help you decide whether to stick with Original Medicare or buy a Medicare Supplement Plan to help pay for your Part B premiums and costs. Medicare Open Enrollment is still going on, but not for long! It will be over December 7, so read on to find out how you can be better prepared for next year.

Medicare Part A Premiums/Deductibles

money bills spread out on a table with a stethoscope on top of it.
Medicare Part A (hospital insurance) deductible has one up $76 dollars.

Medicare Part A is hospital insurance, and covers things like skilled nursing facilities, inpatient hospital stays, and some home healthcare services. If you are 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years, then you will be eligible for premium-free Part A.

The Medicare Part A inpatient deductible that you must pay when admitted to the hospital will be $1,484 for each benefit period in 2021, which is an increase of $76 from $1,408 in 2020. The breakdown for 2021 is:

  • Days 1-60- $0 coinsurance for each benefit period
  • Days 61-90– $371 coinsurance per day of each benefit period
  • Days 91 and beyond- $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days- you pay all costs

Medicare Part B Premiums/Deductibles

Medicare Part B is medical insurance and covers such things as doctor visits, outpatient hospital services, durable medical equipment (DME), and certain home health services. The government had indicated that  Medicare Part B premiums would not increase by more than  25% in 2021.  CMS’ announcement has now given us the exact amount they will increase by: Medicare Part B premiums for 2021 will be $148.50, which is an increase of $3.90 from $144.60 in 2020. Your premium amount may be higher depending on your income:

chart with different income ranges and monthly part b premiums.

CMS also announced that the annual deductible for Medicare Part B will be $203 in 2021, which is an increase of $5 from $198 in 2020. You will continue to  pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment after this $203 deductible is met. 

Considering A Medicare Supplement Plan

Although the costs are not going up by too much next year, for some who are on a fixed income or a tight budget, an almost $4 a month rise in premiums can be a lot. On top of that, the 20% coinsurance you will have to pay could increase with the rising costs of healthcare. Luckily there are ways to help pay for coinsurance and save money. 

Medicare Supplement Plans are perfect for beneficiaries looking to save money and have more of their medical care covered. There are 10 different Medicare Supplement Plans to choose from, each with different price points and coverage options. If you are interested in looking into these plans but do not know where to start, allow an EZ.Insure agent to help. Our licensed agents work with the top-rated insurance companies in the country and can compare plans in your area in minutes. We will assign you one and only one agent who will go over your budget and medical needs. They will compare Medicare Supplement Plans to find the one that is best for your needs. What’s even better is that all of our services are free! To get instant free quotes, simply enter your zip code in the bar above, or to speak directly to an agent, call 888-753-7207.