How can I estimate my total Medicare costs if I have a chronic condition like diabetes?
Answered by 8 licensed agents
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.
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.
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.
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.
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
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.
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.
