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

Steven Whetstine · Answer

Long-Term Care!

Medicare does not cover long-term care needs specifically.  It may cover for shorter term care needs such as skilled nursing care for rehabilitation or hospice.  

Long term care expenses can be catastrophic financially.  

Also, Long term care costs can also vary according to geographic location.  

Many assume Medicare will cover these costs, children will take care of them, or it will not happen to them.  However, children often have to work or have children of their own to care for or may be separated by distance and relocation expenses may be involved.  Perhaps, assistive devices need to be installed such as grab bars, ramps, non-slip devices, etc.  Also, a child or a Medicare beneficiary may not feel comfortable helping or receiving help with some activities of daily living such as toileting.

Long-term care can also vary by need and be provided in a number of different ways.  A Medicare Beneficiary may need partial long-term care to assist or may need full-time care.  It can be provided in various settings to include at home, in assisted living facilities or in nursing homes which can vary greatly in cost.  

The bottom line is that Medicare does not provide coverage for chronic conditions that impact one cognitively or impact someone to where they cannot perform two or more activities of daily living such as eating, bathing, dressing, transferring, toileting, or continence.  

Finally, there are multiple ways to address long-term care that are non-insurance and insurance based outside spending down assets.  Some of the insurance plans can include long term care insurance, life insurance policies with long term care riders, and some annuities may have options to assist with long term care costs such as fixed indexed annuities.

Luke Rhoads · Answer

One hidden Medicare expense that catches many people off guard is the cost of long-term care  such as nursing home or extended in-home care.

Darlene Murphy · Answer

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

Steve Thornton · Answer

Dental, vision, and hearing care.
Original Medicare doesn’t cover routine dental cleanings, eye exams, hearing aids, or dentures. Many people don’t realize this until they’re hit with a big out-of-pocket bill.

Consider a Medicare Advantage plan that includes these benefits, or look into standalone coverage if you stay on Original Medicare.

***Medicare Melanie*** · Answer

Hidden Medicare expenses can be a scary thought. While the costs of your plan, such as copays and deductibles aren’t necessarily hidden, because they are in your summary of benefits, they can be surprising. 

Another consideration is what type of Medicare you have. Here’s some examples below. 

Medicare Supplement - If you have a Medicare Supplement, there’s usually less costs for you at the doctor. If you have a Medicare Supplement Plan G, your only out of pocket costs is typically the Part B deductible.

Medicare Advantage - If you have a Medicare Advantage plan, the costs can be astronomical if you get very sick. You are responsible for your share of costs (deductibles, coinsurance, and copays) until you reach your maximum out of pocket for that year, which can be upwards of $14,000 in out of network combined situations. 

Some costs that aren’t covered by Medicare Supplements, nor Medicare Advantage plans include travel, custodial care, and long term care. These are costs you would have to pay all on your own, or have additional coverage for. 

Licensed Broker, Medicare Melanie and her team  recommend that you have a thorough analysis of your financial situation and consider ‘gap protection’ for the gaps stated above. 

Some examples of gap coverage include;

Long term care insurance
Short term care insurance
Hospital Indemnity
Cancer Indemnity
Heart Attack/Stroke Indemnity

God Bless.

Steven Bleicher · Answer

This should not be the case BUT if you are ever hospitalized and you chose an MA Advantage plan, not only will you have a steep deductible but you’ll need to remember that you will be responsible for a number of days in the hospital (up to seven) that will be applied toward the deductible. Then, every new calendar year, the deductible starts all over again and likely at a higher cost!

Answered by Steven Bleicher on June 7, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

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

Humara Riaz · Answer

Medicare only covers short-term skilled nursing care (e.g., rehab after a hospital stay), and only under strict conditions:

After a qualifying 3-day inpatient hospital stay

Up to 100 days, and only fully covered for the first 20

You pay $204 per day (in 2025) for days 21–100

$0 coverage after 100 days

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?

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