Plan for healthcare costs that aren’t covered by Medicare

Unfortunately, Medicare doesn’t cover everything. If you need care beyond what Original Medicare offers, you’ll generally need to make up the difference. Knowing what Medicare pays for (and what it doesn’t) may help you prepare to handle out-of-pocket medical expenses.

Anticipating out-of-pocket costs

To start, let's take a look at situations where out-of-pocket costs can occur.

Original Medicare Part A costs

Generally, most people who’ve worked and paid taxes don’t pay a premium for Original Medicare Part A. Original Medicare Part A helps cover hospital stays and nursing care but not doctors' visits or long-term care.

There are some out-of-pocket costs you’ll have to pay on your own. For example, you generally won’t have to pay a premium for Original Medicare Part A if you paid payroll taxes when you were employed. However, there is a deductible you’ll have to meet before your Original Medicare Part A benefits kick in. 

In 2021, the annual deductible is $1,484 per benefit period before the plan pays for hospitalizations. Generally, it covers about 80% of Medicare-approved inpatient costs for the first 60 days of a hospitalization. If your stay is longer than that, or if a service is above the Medicare-approved amount, you'll be responsible for paying extra.

Original Medicare Part B costs

This pays for a portion of doctors’ appointments, outpatient procedures, laboratory tests, ambulatory care, mental healthcare and some home health services. The Original Medicare Part B premium in 2021 is $148.50 a month (or higher, depending on your income)—plus an annual deductible of $203.

Medicare Part C costs

Also known as Medicare Advantage, these plans include Original Medicare Part A and Part B benefits. While Original Medicare generally does not cover dental and hearing, Medicare Advantage plans may include additional coverage for routine dental and hearing care, along with prescription drug coverage. 

That doesn't mean out-of-pocket costs will not pop up. Fortunately, all Medicare Advantage plans offer an annual maximum out-of-pocket limit, after which you pay nothing for covered services.

Medicare Part D

If you don’t choose a Medicare Part C plan that includes prescription drug coverage, but still want prescription coverage, you may be able to enroll in a stand-alone Part D prescription drug plan. Most plans require a monthly premium, deductibles and copays.

Note that there is a late enrollment penalty, opens new window for signing up for Part D after the deadline. Be sure to check each plan’s drug list before you decide on a plan, to ensure that the medicines you take are included.

Other out-of-pocket expenses

Original Medicare generally does not cover dental, vision and hearing services. Routine dental care, prescriptions, eyeglasses and hearing aids are a few things Original Medicare Part A and Part B don’t cover. Long-term care or custodial care, which differs from the nursing care covered under Original Medicare Part A, also is not covered.

If you’re traveling outside of the U.S., your Medicare coverage won’t travel with you. If you need healthcare while traveling internationally, you’ll likely have to pay for it yourself.

A Medicare Advantage plan may help

Many Medicare Advantage plans offer benefits not covered by Original Medicare—things like prescription drug coverage, routine dental, vision and hearing care.

Another feature Medicare Advantage offers is the security of an out-of-pocket spending limit each year. That amount varies from plan to plan and can change each year.

Humana answers your Medicare questions

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