What's one hidden Medicare expense that people don't think about until it's too late?
Answered by 21 licensed agents
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.
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.
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
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.