Your Money
THIS IS YOUR WALLET ON MEDICARE
Your out-of-pocket spending on treatment depends on the insurance plan or plans you have. In these four common scenarios, see your possible costs under three coverage options: original Medicare, Medicare Advantage, and Medicare plus Medigap and a Part D drug plan.
AN AARP NEED TO KNOW GUIDE
SCENARIO #1
ACCIDENT!
You trip on a rug at home and—ouch!—break your arm. A neighbor drives you to the emergency room, where a doctor sets the bone and prescribes painkillers. A few weeks later, a specialist removes the cast and prescribes occupational therapy to restore full function in the arm.
You saved $940 by not taking an ambulance. Medicare usually won’t cover that unless traveling in another vehicle for care will endanger your health.
SCENARIO #2
SUDDENLY SICK ON VACATION
You wake up in your hotel three states away from home with a high fever, difficulty breathing and a general sense of feeling awful. You find an urgent care center nearby where they run tests, take a chest X-ray, diagnose you with pneumonia and send you to a hospital for a one-night stay just to be safe. You are released the next day with prescriptions for an antibiotic and cough suppressant.
Ask whether you are an inpatient if you stay overnight. Outpatients aren’t covered by Part A and can be denied skilled nursing care later on.
SCENARIO #3
EMOTIONAL SUPPORT
You’re depressed and anxious, and your state of mind is affecting your work, home life, sleep, appetite and energy. Your doctor guides you through a three-month course of weekly psychotherapy and prescribes medication to help keep your brain chemistry steadier.
Meds for mental health can be very costly. Trying generics, especially those in lower tiers on your plan formulary, can save you plenty.
SCENARIO #4
CHRONIC PAIN
At your annual wellness visit, you tell your primary care physician that your knee is increasingly painful. She refers you to a joint specialist, who orders tests, then diagnoses you with osteoarthritis. The upshot: six months of daily pain and arthritis meds, two corticosteroid shots and short-term physical therapy.
MA plans often have set copayments for each specialist visit and specific services, so multiple visits can cost you more than OM’s coinsurance.
NOTE: Each scenario assumes you already met your annual Part B deductible ($240 in 2024) and are taking generic drugs when available. Scenarios include monthly plan premiums across the length of the treatment regimen. Premiums and prices are for 2024.
MONTHLY PREMIUMS EXPLAINED
Original Medicare (Parts A and B only)
► Part B: $174.70
*Except if your income is high or very low.
TOTAL: $174.70
Medicare Advantage (Drug coverage included)
► Part B: $174.70
► MA (average): $18.50
*Monthly premiums range from $0 to $200.
TOTAL: $193.20
Original Medicare Plus Drug Coverage and Medigap
► Part B: $174.70
► Part D prescription drug coverage (average): $34.70
► Medicare supplement insurance “G” policy (average): $155.00
TOTAL: $364.40