How to Pay for What Medicare Doesn’t Cover

Medicare will pay for a lot of your health care expenses. But whether you have Original Medicare or a Medicare Advantage Plan, you'll still have medical costs that your plan won't cover. Those expenses you have to pay, called out-of-pocket fees, can add up fast.

But there's good news. With a little research, you can get help from supplemental plans and other programs that will cut down your medical bills and keep more money in your pocket.

If You Have Parts A & B: Ways to Pay Less

Most people on Medicare have Original Medicare, also known as Medicare Parts A and B. While Original Medicare should cover most of your care, it has these gaps.

Gaps in coverage:

  • Original Medicare doesn't cover some essentials. For instance, it does not pay for most prescription drug costs.
  • Even when Medicare covers a treatment, you still have to pay copays and coinsurance.
  • Most people have to pay a monthly fee, called a premium, for Medicare.

Fortunately, Medicare offers these choices to supplement your Original Medicare.

Prescription Drug Plans. Also known as Medicare Part D, a Prescription Drug Plan will help you pay for prescription medicines. You'll pay an extra fee each month for the plan, but you'll probably save a lot on pharmacy expenses.

Private companies sell prescription drug plans, but you can sign up for them through Medicare. To compare plans in your area and sign up, use the Medicare Plan Finder. Note: you will pay a higher premium if you don’t sign up for Medicare Part D when you sign up for Original Medicare.

Medigap plans. Just like it sounds, a Medigap plan will fill some of the gaps in coverage with Original Medicare. Medigap plans help:

  • Pay copays and coinsurance.
  • Lower the deductible, which is the amount you have to pay out-of-pocket before Medicare pays toward your care.

What don't Medigap policies cover? Most don't pay for long-term care, dental care, hearing aids, eye exams, or eyeglasses.

To get a Medigap plan, you have to have Original Medicare. As with a Prescription Drug Plan, you also have to pay a monthly fee for a Medigap plan. The plans vary on what they cover and how much they cost. You can use the Medicare Plan Finder to choose a Medigap plan in your area.

Continued

Medicare Advantage (Part C)

While Medigap and Prescription Drug Plans are things you add to Original Medicare, Medicare Advantage plans are an alternative to Original Medicare.

Medicare Advantage plans are private health plans that contract with the federal government to offer Medicare benefits to enrollees. Medicare Advantage plans may cover things that Original Medicare doesn't. For instance, most have built-in drug coverage. Some may have additional benefits -- like dental, hearing, vision, or wellness programs. You may have to pay an extra monthly fee for a Medicare Advantage plan on top of your monthly Medicare fee. In addition, you must go to the providers in the plan’s network.

If you sign up for Medicare Advantage, you can't get a Medigap plan. But if your Medicare Advantage plan doesn't already have drug coverage, you can add on a Prescription Drug Plan.

Each state has many health plans to choose from. If you pick one, you'll use it instead of Original Medicare.

Medicare Advantage plans can change each year. What's covered might change. How much you pay may change, too.

More Ways to Lower Your Costs

Even if you have a Medigap plan and prescription drug coverage -- or a Medicare Advantage plan -- you'll still have medical costs that aren't covered. You may qualify for financial aid to pay all or part of these costs. There are also some other programs and pointers that may help.

Qualified Medicare Beneficiary (QMB) Program. Available to low-income Medicare beneficiaries. This program helps you pay for your Medicare Part A and Part B premiums, as well as co-insurance, copayments, and deductibles. Contact your state Medicaid office to find out if you qualify.

Specified Low-income Medicare Beneficiary (SLMB) Program and Qualified Individual (QI) Program. These two programs are largely the same, but with different eligibility standards. The programs help low-income Medicare beneficiaries pay for their Medicare premiums. Contact your state Medicaid office to see if you qualify.

Qualified Disabled and Working Individuals (QDWI) Program. Individuals who qualify for Medicare because of disability, rather than age, may receive help paying their Medicare Part A premiums through this program. Contact your state Medicaid office to apply.

Continued

Medicare Extra Help Program: This program helps low-income Medicare beneficiaries pay for their prescription drugs. If you qualify for QMB, SLMB, QI, or QDWI, as described above, you automatically get Extra Help.

Pharmacy Assistance Programs. Some states offer programs that will help you pay for medications. Many drug companies run similar programs themselves.

Cheaper drugs. To lower your expenses, ask your doctor or pharmacist if a cheaper generic drug might work as well as a brand-name medication.

Additional insurance. Depending on your needs, it might make sense to pay for an extra health care policy. You could get a policy for a specific need, like dental care.

Veterans' benefits. If you've served in the military, veterans' benefits may cover some expenses that Medicare doesn't, like prescription drugs.

Long-term care planning. A lot of people think that Medicare covers long-term care -- in a nursing home, for instance -- but it doesn't. Medicaid usually does, but you must have a very low income and low assets to qualify. One possibility is buying long-term care insurance, which will pay at least some of the costs. However, most experts suggest buying it early -- between ages 52 and 64 when the costs will be lower.

Expert advice. Every state has a State Health Insurance Assistance Program, called SHIP. An advisor there can help you figure out if you need more than just Medicare.

Call Medicare at 800-633-4227 to find the number for the SHIP in your state. Or go to Medicare.gov and pick your state in the pull-down menu called "Find someone to talk to."

WebMD Medical Reference Reviewed by Sarah Goodell on February 08, 2016

Sources

SOURCES:

Centers for Medicare and Medicaid Services: "What Medicare Covers," "What's not covered by Part A & Part B?" "Supplements & other insurance," "What's Medicare supplement (Medigap) insurance?" "Your Medicare Coverage: Hospital Care," "Medicare Coverage of Durable Medical Equipment and Other Devices," "Decide how to get your Medicare," "Medicare Advantage Plans," "Catastrophic coverage," "How do Medicare Advantage Plans work?" "Medicare & You," "How to Get Drug Coverage," "Save on Drug Costs," "Medicaid," "Medicare Advantage Plans Cover All Medicare Services," "Medicare Savings Programs,"  "What is Long-term Care?" "Help with Medical and Drug Costs," "Part B Costs," "Prescription drugs (outpatient) limited coverage," "Medicare Prescription Drug Coverage(Part D)."

Social Security Administration: "Income and resource requirements for the Extra Help with prescription drug costs."

Kaiser Family Foundation: "Medigap: Spotlight on Enrollment, Premiums and Recent Trends," "Medicare Advantage."

Families USA: "Stand Up for Health Care: Filling the Financial Gaps in Medicare Coverage."

Marc Steinberg, deputy director of health policy, Families USA.

Medicare Interactive: "Can I Have Both Medicare and Veteran's Benefits?"

AARP: "10 Misconceptions about Long-Term Care Insurance."

NIH Senior Health: "Long-Term Care."

© 2016 WebMD, LLC. All rights reserved.

Pagination