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How to Protect Yourself from the Gaps in Medicare

Gaps in MedicareHealth care costs are climbing, which can make saving enough money for retirement somewhat daunting. Even when you are covered by Medicare Supplement insurance, you may expect to spend thousands of dollars on medical services every year. If you need nursing home care, the expenses can be astronomical. The improvements in health care have also caused people to live longer, thus requiring more savings for medical costs. The good news is, you can now know what to expect in terms of Medicare: what it does cover and what it doesn’t cover – pending your specific medical needs.

What Costs Can You Expect When Covered Under Medicare

It is estimated that for those 70 and above Medicare is spending $7,566 every year.These include expenses for both Part A inpatient services, Part B doctors and services, hospital outpatient services, drugs, skilled nursing homes, in-home care, as well as hospice. By the time you turn 80, Medicare will be spending $11,618 per year to pay for your medical expenses, and by age 90, they are spending $14,745 every single year. These are certainly high numbers, but how much do you really have to pay out-of-pocket?

In 2010, those aged 65 to 74 paid $4,020 a year. Older adults 75 to 84 spent $5,245 and 85+ spent $8,191 a year. While these numbers may seem daunting, keep in mind that they are averages.our out-of-pocket expenses could actually be much higher if you don’t have the right coverage.

Why Is Medicare Not Always Enough?

It is essential to understand just how pertinent Medicare can be in helping you in funding medical costs, but how there is also a gap that you need to prepare for. To be specific, it is estimated that 70% of older adults will need services that Medicare will not always cover – including long-term care and nursing facilities.

Typically, you can estimate that Medicare will cover approximately 80% of your expenses, and you will cover the other 20%. But Medicare has no stop loss, and for many services there is an upper cap, after which Medicare will not pay any more.

One of the biggest risks you’ll face is expenses for nursing home coverage. While Medicare does have limited coverage for a long-term care facility, there are qualifying stipulations:

> You need to have had a qualifying hospital stay of at least three days.
> The care you receive at the facility needs to be related to the treatment you were receiving in your initial hospital stay.
> Medicare only covers 100% of these costs for 20 days, and then all except a $157.50 per day copayment for the following 80 days in 2015.

Unfortunately, at the conclusion of the 100 days the costs become your responsibility.

Beyond nursing care facilities, it’s important to remember coverage for home health services is also limited. If you have Medicare Part A, you’re allowed up to 100 visits after a hospital stay. However, a doctor has to validate that you are homebound and that you need services such as occupational therapy or speech therapy, for you to be covered.

What to Do?

As you can see, Medicare certainly does not cover everything, and the out-of-pocket costs you might face can be huge. This is why it’s essential to have either a Medicare Supplement plan or a Medicare Advantage plan. Medigap plans help cover the gaps in Medicare, protecting you against large medical bills. To learn more how Medigap plans work, visit our Medicare Supplement Plans page.

Furthermore, most people should also consider a long-term care insurance policy. These policies are specialized and cover a variety of services, including nursing homes and personal care beyond the 100 day limit of Medicare. Medicare supplement plans do not offer this coverage.

Give your Personal Advisor a call, or visit us at our website if you’d like some more information on how to protect yourself against long-term care expenses or other expenses that aren’t covered by Medicare.

Wiley Long

Wiley Long

Wiley Long is president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. When he’s not working he’s likely to be skiing and hanging out with his wife and son, and enjoying the live music scene around Fort Collins, Colorado.
Wiley Long

 

 
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