Medicare and Costs

Many first-time Medicare beneficiaries expect the federal government health insurance program to pay for everything related to their health care. As we all learn quickly…it does not. Tallying how much you pay out of pocket for Medicare each year can lead to serious sticker shock.

When you add up all the premiums, deductibles, co-pays and coinsurance, the average Medicare enrollee can expect to spend thousands of dollars a year to get medical care. And the costs can swing wildly each year, depending on the beneficiary’s health, where you reside, and whether the government and insurers have instituted any price increases — or decreases. Individual plans can also tinker with the services and drugs they cover.

An annual reminder and bottom line:  Even if you’re satisfied with your current coverage, it’s a good idea to shop around, as you just might find a better deal.

Researching the website for the Centers for Medicare and Medicaid Services (CMS), you will find an online tool to assist in cost calculations for Original Medicare and Medicare Advantage.

The cost is pegged to the particular Medicare option. For example, if you live in Buffalo, NY, are in good health, enroll in Original Medicare and buy a Medicare supplement, or Medigap, policy and a Part D prescription drug plan, all with mid-priced premiums, CMS estimates that you’ll pay nearly $5,600 out of pocket in 2019. If you sign up for a Medicare Advantage plan that includes prescription drugs with a mid-priced premium, CMS predicts you’ll pay about $4,600 next year. These are just estimates, of course, but they can help you choose the policy that’s best for your health care needs and financial situation.

Fortunately, there are some federal and state programs that can help beneficiaries who can’t afford hefty out-of-pocket costs. If you qualify for Medicaid, the federal-state health insurance program for people with low incomes and individuals with disabilities, it will pay some or all of your out-of-pocket expenses.

JD Miller

About JD Miller

John D. Miller is the founder/owner of Home Care Partners, LLC, a Massachusetts business providing private duty, personalized in-home assistance and companion care services to those needing help in daily activities and household functions. Phone: (781) 378-2164 Email: Website:

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