What's one hidden Medicare expense that people don't think about until it's too late?

Question

Chris Bumgardner · Accepted Answer

Skilled Nursing Facility Costs.  Days 1-20, Medicare pays 100%.  Days 21-100, the member pays a daily co-pay.  After 100 days, Medicare no longer covers expenses.

Larry Dalton · Answer

They do not understand the Medicare Advantage MOOP limits, which the federal government has set at $9,350 for Medicare Advantage plans in 2025.  You may be expected to pay this maximum out-of-pocket cost annually for the covered services.  But some carriers allow you to choose or set lower limits on possible out-of-pocket expenses.  

Under traditional Medicare, with a Medigap plan, the out-of-pocket expenses are determined by the type of Medigap plan you choose.  The drawback with these types of plans is that the insurance carriers underwrite these Medigap plans and have the right to increase monthly premiums.  However, they do not have the right to pick or choose or in any way limit your services, and must pay according to your Medigap plan wherever traditional Medicare is accepted.

Melonie Wood · Answer

I carefully review everyone's plan including giving the members an enrollment book that clearly outlines costs for providers/ facilities/ medications, so my members do not have "surprise" costs

Nikki Rowland · Answer

LONG TERM CARE! No one thinks about the possibility of having to have a caregiver or even staying in a facility. Its is a HUGE problem and regular Medical Insurance does not cover it. You either have to have money in the bank or assets you're willing to give up. It is so expensive.

Answered by Nikki Rowland on April 29, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

Darlene Murphy · Answer

Long-Term Care or extended rehab care in or out of facilities. There is no coverage for custodial or ADL care.

Diana Garner · Answer

Late enrollment penalties are often overlooked. When working with the right broker/agent, they should educate you on all aspects of Medicare and your options.

Medicare Part B and Part D (prescription drug plans) both have a late enrollment penalty if you go without creditable coverage for a period of time.

Gregg Matheny · Answer

The biggest expenses that often creep up on folks are hospital cost and prescription drug deductibles on a Medicare advantage plan. On a Medicare supplement plan the annual rate increase can often sneak up and surprise folks. No matter what plan you’re on if your income is on the high side an IRMAA part B and part D can be A huge shock.

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Bruce Kern · Answer

Hospital co-pays that the clients don't realize that they have until they leave the hospital and reaceive there Bill.

Lea Ayres · Answer

Skilled Nursing. For anyone that has a Medicare Advantage plan Skilled Nuring is always a 2nd thought. After your plan benefit is used up Skilled Nursing becomes very expensive. We at MediConnect have product to protect against what can turn into a very expesive stay.

Answered by Lea Ayres on March 12, 2025

Broker Licensed in PA, CT, MD & 8 other states

Answered by Lea Ayres Medicare Insurance Agent

Jill Belvin · Answer

Dental is an expense that traditional Medicare does not cover and that can be very expensive to cover depending on what is required. Some Medicare Advantage plans do include this coverage to some extent.

Answered by Jill Belvin on March 24, 2025

Agent Licensed in TX, AZ, FL, MI & NJ

Answered by Jill Belvin Medicare Insurance Agent

Frank Woerner · Answer

Original Medicare Part A & B usually doesn't include prescription drug coverage. Make sure it's part of your package. Dental insurance too is a needed coverage as we get older.

Michael Young · Answer

Today I spoke to a retiree referred by a current client. She had dropped her Medicare Supplement because she was healthy and not seeing a return on her money. One of the costs she never considered was a heart attack. Under Part B of original medicare, she is responsible for her Part B Deductible ($257 for 2025) plus 20% of the cost. A heart attack can easily cost $5k or more dollars with just Part A and Part B.

Answered by Michael Young on March 31, 2025

Broker Licensed in CA, AZ, ID, NC & NV

Answered by Michael Young Medicare Insurance Agent

Mike Henry · Answer

Long term care. Most seniors think that Medicare will cover that.  It will pay while in recovery from an illness or accident. Not extended care for like dementia or other problems.

Aisha Saleem · Answer

Sometimes people don't think about the deductibles and out-of-pocket maximum until it's too late. It's best to make sure you weigh all the information of each plan compared to your expected use and situation in order to pick the best option while choosing a plan.

Answered by Aisha Saleem on March 13, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Adam Ashby · Answer

Although it is talked about by everyone - networks is one thing that can create hidden expenses. For example, knowing that your Primary Care Provider is in network and able to meet your needs is great, but if you have a dental provider who is not a part of the network and you have significant needs for dental that can become a huge setback. Another issue we see is individuals not understanding deductibles, whether Medical or Prescription can cause an unexpected bill especially at the first of the year.

Answered by Adam Ashby on May 19, 2025

Broker Licensed in CO, NE, UT, WA & WY

Answered by Adam Ashby Medicare Insurance Agent

Duane Boebel · Answer

How individuals will cover their out of pocket copays under the Medicare program. There are a number of ways to cover them.

Adriane Williams · Answer

Prescription drug costs. And that their doctor may not be in network and they may have to pay out out of pocket to see them.

What's one hidden Medicare expense that people don't think about until it's too late?

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What's one hidden Medicare expense that people don't think about until it's too late?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

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A non-government resource website