Even with Medicare, you're typically responsible for premiums, deductibles, copays, and coinsurance, plus costs for things Medicare doesn't cover at all, like most dental, vision, and hearing care.
Medicare covers a lot, but it doesn't cover everything, and it rarely covers anything at 100 percent.To start, there are premiums. Part B has a monthly premium that most enrollees pay, and if you have a Part D drug plan or a Medigap policy, those have premiums too. These are costs you pay every month regardless of whether you use care.Then there are the costs when you actually receive care. Part A has a deductible per benefit period for hospital stays, not an annual deductible. Part B has an annual deductible, and after that you generally pay 20 percent of the Medicare-approved cost for most services. That 20 percent has no cap under Original Medicare alone, which surprises a lot of people.Prescription drugs have their own cost-sharing through Part D, including deductibles, copays, and coinsurance that vary by the drug tier.Then there's what Medicare simply doesn't cover. Routine dental care, eye exams and glasses, hearing aids, and most care received outside the United States are not covered under Original Medicare. These can become significant expenses as you age.Medigap policies help cover many of the gaps like deductibles and that 20 percent coinsurance. Medicare Advantage plans handle cost-sharing differently, with copays and an annual out-of-pocket maximum. Costs vary by plan and year, so reviewing your specific coverage is always worth doing.
Utahns with limited income may qualify for the Utah Medicare Savings Program, which can help pay Part B premiums and in some cases other cost-sharing. Contact your local ADRC to find out if you qualify.
For you, this means budgeting for Medicare isn't just about the monthly premium, it's about understanding what you could owe if you need significant care and deciding how much of that risk you're comfortable carrying.
Our Commitment to Reliable Medicare Information
At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.
To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.
Our Medicare plan pages and comparison tools are powered by CMS datasets, including:
When possible, we link to the original CMS resources so you can review the source material directly.
We follow the CMS release schedule and update our website as new data becomes available.
We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.
We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.
We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.
Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.
CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.
This includes:
All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.
We keep internal records of the CMS dataset versions used on our site.
If CMS issues corrected or revised files, we update our website to reflect the latest available version.
Please keep the following in mind:
For personalized Medicare assistance, please use these official resources: