How can I estimate my total Medicare costs if I have a chronic condition like diabetes?

Question

Joseph Bachmeier · Accepted Answer

Estimating your total Medicare costs will depend on how many doctor visits you have and the cost of any diabetic medicine you take which can be outlined in your Part D drug plan. I can provide you with a PDF outline of your costs.

Answered by Joseph Bachmeier on March 25, 2025

Agent Licensed in PA, AZ, DE & 5 other states

Answered by Joseph Bachmeier Medicare Insurance Agent

Alondra Arce · Answer

Honestly, if you’ve got something like diabetes, the best way to estimate your Medicare costs is to look at what meds and treatments you need regularly, like insulin, test strips, doctor visits, stuff like that. Then check what’s covered under Part B and Part D. Some plans are better than others depending on what prescriptions you take, so it helps to compare. Medicare’s website actually has a tool where you can plug in your prescriptions and see how much you’d pay with different plans or I can also help you estimate the costs depending on the plans that are available in your area.

Answered by Alondra Arce on April 14, 2025

Agent Licensed in CA, AL, AR & 14 other states

Answered by Alondra Arce Medicare Insurance Agent

Keaton Lewis · Answer

It can be tricky on how to get an exact estimate, but typically you can see what your costs would be for a specialist visit that would treat your chronic condition. On top of that, you can easily see what your maximum out-of-pocket (MOOP) would be for your plan. The nice thing there is that your MOOP is your safety net, and if you had your worst year ever medically, that would be the total amount you would pay in a year's time, no matter how many treatments or doctor's visits you had.

Answered by Keaton Lewis on April 14, 2025

Broker Licensed in ID, AZ, CA & 11 other states

Answered by Keaton Lewis Medicare Insurance Agent

Russ Stockton · Answer

Thank you for your inquirey.
You can estimate your drug cost on Medicare.gov or with a broker.  This estimate would be on what you are currently taking.  

As far as the medical estimate, it would depend on how you are insured.  If you are on a plan G Medicare Supplement, you know your out of pocket would be your premium plus the part B deductible, $257.

If you are insured on a Medicare health plan, also known as Medicare Advantage, it would depend on your medical usage for the year.  Medicare Advantage plans have out of pocket maximums.  If you are on a plan with a $5,000 out of pocket maximum, you know that is the worst case scenario, provided you are only getting Medicare covered services.  

Thank you,
Russ Stockton

Norman Smith · Answer

You should be able to have your doctor estimate your out-of-pocket costs, what the treatments are, and an estimate of costs with treatment. Your Part B should cover 80% of all treatments, and if you have a Supplement plan, that should cover the balance minus your $257 Part B Deductible. And as long as your plan doesn't hold you responsible for excess charges, that should be all the costs, medically. If you go to Medicare.gov, and look at the prescriptions, that's where your costs may really lie. Unless your drugs are administered by a medical professional at a medical facility, you may incur drug costs, depending on your plan.

Answered by Norman Smith on April 6, 2025

Agent Licensed in FL & PA

Answered by Norman Smith Medicare Insurance Agent

Yasmery Vargas · Answer

You always have the option of going on to medicare.gov and researching medications as well as plans based on need.

Michael Kim · Answer

With a Medicare Advantage Plan if you have a chronic condition like diabetes the cost are minimal. Their are Chronic Plans that are specifically designed for your chronic condition so like I said the cost would be minimal to you.

Answered by Michael Kim on May 12, 2025

Agent Licensed in NV, AR, AZ & 18 other states

Answered by Michael Kim Medicare Insurance Agent

Fred Manas · Answer

To estimate total Medicare costs for a chronic condition like diabetes, you need to consider several factors: Part A and B premiums, deductibles, coinsurance & potential costs of prescription drugs. You can use tools like the Medicare Cost Estimator to get a general idea. 
Here's a more detailed breakdown:
Part B Premium: Most people pay a standard monthly premium for Part B, which is $185 in 2025. However, those with higher incomes may pay more. Part B Deductible: The annual deductible for Part B is $257 in 2025. 
Coinsurance: You typically pay 20% of Medicare-approved costs for Part B services. 
Prescription Drug Costs: If you need insulin or other medications for diabetes, you'll need to enroll in a Part D prescription drug plan. You may be able to get Extra Help with costs if you have limited income & resources. Insulin Cost: The Inflation Reduction Act capped insulin copays at $35 per month for covered insulin products starting in 2023. 
Medicare Advantage Plans: If you choose a Medicare Advantage plan, you may have additional monthly premiums, but these plans often include prescription drug coverage & may offer additional benefits for those with chronic conditions. 
Other Factors: Your costs can also vary based on your specific medical needs, the type of care you receive (inpatient vs. outpatient), & whether you have additional coverage like Medigap or retiree health insurance. 
Steps to Estimate Your Costs:
1. Use the Medicare Cost Estimator: The Medicare website has a tool that can help you estimate your costs. 2. Consult your Healthcare Providers for more specific information about what's covered & what you can expect to pay for your treatment. 3. Review Your Medicare Summary Notice (MSN): After receiving healthcare services, review your MSN to see how much you paid & what was covered. 4. Compare Plan Options:  If you're considering a Medicare Advantage plan, compare the monthly premiums, deductibles, coinsurance & drug coverage.  5. Contact 1 800 Medicare

Gary Henderson · Answer

If you have a Medicare supplement plan, you'll have an annual deductible for all your doctor visits this year. It's $257. Once you've met your deductible, you're covered at 100% for the rest of the year, then includes hospitalization also 
Your prescription drug coverage depends on your prescription drug plan and the type of medication you take. Generic medications are usually $0 to $5 for one month's supply insulin if you take, that is capped at $35 
If you'd like to have this discussion in more detail, give me a call at 737-530-4626 pick option two. That's my direct line. If I'm busy, just leave a message and I'll call you back

David Christian · Answer

Hello - this is a tricky question to answer. It comes down to the plan you have. Prescription wise - most injectable diabetic prescriptions have a copay cap of $35 per. Then most plans are going to give you diabetic supplies at $0 copay. This may or may not include continuous glucose monitors because those are considered Durable Medical Equipment. I'm not sure what other costs may come to you, but if you are speaking of doctor visits, you would factor in the copays your plan has for Primary Care & Specialists visits.

Answered by David Christian on May 5, 2025

Broker Licensed in CA & TX

Answered by David Christian Medicare Insurance Agent

Jeff LeSourd · Answer

Once you accept Medicare Part B, the monthly cost of that benefit in 2025 is $185/month. Currently insulin only costs $35/month which is a huge cost savings.  There may be other Rx drug costs that can be analyzed and estimated by a Medicare professional. They can help get the least expensive Rx drug plans for your specific Rx costs.
You can also go to medicare.gov and do an analysis of Part D Rx drug plans and get a rough estimate for your zip code.

Wes Drew · Answer

It's important to consider the cost of your medical care and prescriptions drugs, while also considering the cost of your plan premium (if any) and how those costs may change over time. Since some plans are designed with anticipated rate increases as you age, looking at your total cost and not just the premium cost of the plan you choose will help determine which plan you want now and may help you plan for a change to that plan in the future.

Answered by Wes Drew on April 9, 2025

Agent Licensed in IL

Answered by Wes Drew Medicare Insurance Agent

How can I estimate my total Medicare costs if I have a chronic condition like diabetes?

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