What would my costs look like in a bad health year on Medicare?
The short answer
In a bad health year on Medicare, your costs can range from a few hundred dollars to many thousands, depending on which type of coverage you have and how much care you need.
The full explanation
Think through a scenario where you have a hospital stay, follow-up specialist visits, a procedure, and ongoing prescriptions. Under each type of Medicare, that same year looks very different financially.With Original Medicare and no supplement, you'd pay the Part A hospital deductible, which applies per benefit period, and 20 percent coinsurance for most outpatient and physician services. There's no annual out-of-pocket cap with Original Medicare alone, so a truly bad year can expose you to significant costs.With a Medicare Supplement plan added, most of that coinsurance and many of the deductibles are covered, depending on the plan type. Your monthly premium is higher, but your actual costs during a hard year are much more predictable and often lower overall.With a Medicare Advantage plan, you have an annual out-of-pocket maximum, which is the most you'd pay in a calendar year for covered services. Once you hit that number, the plan covers the rest. That cap can range considerably by plan, so check the specific number before enrolling. You'd also have copays or coinsurance for each service along the way, and drug costs are separate under most plans.Prescription costs in a bad health year can add up quickly too, especially if new medications are prescribed. Plan details and costs change annually, so verify current figures with your specific plan.
Related Medicare Resources
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Utah has a Medicare Savings Program that helps qualifying lower-income residents with Part B premiums and sometimes other cost-sharing. If cost is a real concern, the Aging and Disability Resource Centers, which serve as Utah's State Health Insurance Assistance Program, can help you understand what financial assistance might be available.
What this means for you
For you, this means the difference between a supplement and no supplement, or between Medicare Advantage plans with different out-of-pocket caps, can easily translate to a $5,000 to $10,000 difference in what you actually pay during a serious illness year.
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