One of the biggest mistakes most seniors make when planning for their retirement is underestimating the cost of their healthcare. While Medicare does cover the majority of your major medical, it does not cover everything.
In addition to what Medicare does cover, there are co-payments and deductibles. For example, in 2019, beneficiaries with hospital stays pay a deductible of $1,364 for a hospital stay of 1-60 days. After that, there’s a per day deductible. These inpatient deductibles add up fast.
Likewise, if you need to use a skilled nursing facility after a three-day stay in the hospital, the first 20 days of care in the nursing facility are free, and then there’s a co-payment of $170.50 per day. For Medicare Medical Insurance (Part B), which covers care by doctors, a person pays a $185 deductible in 2019. After meeting the deductible, a person will typically pay 20 percent of the Medicare-approved fees for the doctors. For example, if a doctor has charges of $500 approved by Medicare, a beneficiary will pay 20 percent of that amount, or $100.
Medicare Prescription Drug plans (Part D) also have co-payments and deductibles, and plans typically have a monthly premium. Most plans have a coverage gap, known as the donut hole, which begins after a certain level of spending. Within the donut hole, people receive a discount of 50 percent on brand-name drugs. When the end of the coverage gap is reached, there is a 5 percent co-payment on future drug purchases. Some people enrolled in Medicare purchase Medicare Supplement Insurance (Medigap) policies to help pay the co-payments, deductibles, and other charges under Medicare.
For those still working at age 65, or those who are 65 and older and have retiree health insurance, coverage through current or former employers will help pay the bills. The policies (the employer coverage and Medicare) are coordinated to provide the most help with co-payments and deductibles. Medicare does not cover custodial care in a nursing home, which can be a major expense after age 65. Only skilled care and rehabilitation services in a nursing home, for medical treatment of an acute illness, are covered.