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High Out of Pocket Expenses for Medicare Beneficiaries and How to Avoid Them

For many seniors, the Original Medicare program provides a foundation for covering different healthcare expenses. However, it doesn’t support everything. Consequently, Medicare beneficiaries who enroll for Original Medicare might face high out-of-pocket costs for uncovered services. Let’s discuss in detail what Original Medicare covers and approaches to expand your services to avoid high out-of-pocket expenses.

Average Costs and Insurance Coverage for Original Medicare Plan

Original Medicare consists of two coverage areas also called different Plans or Parts of Medicare. ”Medicare Part A” supports hospitals and long-term nursing expenses such as hospice care. Furthermore, “Medicare Part B” guarantees doctor’s services, such as outpatient therapies, physician visits, and preventative solutions. The Original Medicare plan includes both “Part A” and “Part B.”

Despite having both parts of insurance coverage, Medicare beneficiaries still find themselves liable for some of their insurance coverage charges. In 2017, AARP stated that elders paid the following bills associated with their Medicare program.

  • $ 1,316 insurance deductible for a hospital facility or long term nursing services center before the start of “Medicare Part A” coverage
  • Approximately $ 658 daily copay for an extended stay with “Medicare Part A.”
  • $ 183 insurance deductible for a medical professional and outpatient visits with the “Medicare Part B” plan
  • About a 20% copay for each supported “Medicare Part B” consultation

Although Original Medicare provides some coverage, retirees still encounter Medicare out-of-pocket expenses in insured facilities. In 2016, the average Medicare patient paid almost $5,460 for their healthcare.

Requirement of Coverage with Original Medicare

While Original Medicare covers medical facilities and clinical services, many recipients expect it to cover all their medical expenses. Unfortunately, this is not the case. Original Medicare offers limited insurance coverage to seniors that includes:

i) Prescription Medicines Coverage

Original Medicare does not provide prescription drugs. In 2017, old adults in excellent health with the Original Medicare paid about $400 on prescriptions. Those unhealthy or with multiple chronic diseases paid as high as $1000. Furthermore, cancer patients can invest more than $1000 in arranging one medication. Medicare Part D covers prescription coverage, though recipients are still accountable for some of the expenses of their medicines.

ii) Dental, Hearing, and Vision Care

Regular dental, hearing, and vision checks are essential for healthy and balanced aging, but the Original Medicare Plan doesn’t cover these services. Therefore, beneficiaries with “Medicare Part A” and “B” should offer these prices out of their budget.

iii) Long-Term Care or Treatment

“Medicare Part A” provides some coverage for long-term treatment. Skilled nursing facilities, hospitals stays, skilled nursing facilities, and even hospice services are covered by Original Medicare. Nevertheless, Medicare coverage would decrease based on the length of the visit.

Steps to Avoid Out of Pocket Expenses

i) Expand your Advantages

One way to manage unexpected Medicare out-of-pocket expenses is by extending your coverage. Medicare Supplement plan and Medicare Advantage (MA) plan offer more benefits than traditional Medicare. These strategies provide all the same benefits as traditional Medicare; however, they also offer additional services. Besides, you can add oral, hearing, and vision services, increase your prescription medicine coverage, and much more.

ii) Review your Insurance Coverage Yearly

Another method to avoid unexpected costs is to evaluate your insurance coverage. Every year, from October 15 to December 7, Medicare holds the AEP (Annual Election Duration). During this period, Medicare beneficiaries can examine their insurance coverage and improve their existing MA plans. People who use this opportunity generally wind up finding more extensive insurance coverage at a better rate.

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