For some Medicare beneficiaries, the pandemic means worrying about more than just their increased health risk from Covid-19. It also raises the specter of large, unexpected medical expenses.
Medicare, the government health insurance program that you generally qualify for at age 65, comes with costs that can surprise beneficiaries. And as the pandemic continues rumbling through U.S. communities, the majority of current and soon-to-be beneficiaries worry most about out-of-pocket costs (66%) and unexpected medical bills (62%), according to a survey by Healthinsurance.com.
More than 1,000 Medicare-eligible individuals age 64 or older were recently polled to explore their views on a variety of topics related to Medicare and health care during the pandemic, which in the U.S. has led to 4.66 million cases and 154,860 deaths.
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Some of the results in the survey over costs echo previous findings from the The Senior Citizens League, an advocacy group for older individuals.
“There are high out-of-pocket costs involved with Medicare,” said Mary Johnson, a policy analyst for the group. “And they start cascading as you age, because you need additional services or you have new conditions diagnosed.
“And that often takes people by surprise.”
About 36% in the Healthcare.com survey have delayed seeing a doctor due to cost at some point — not necessarily amid the pandemic.
The average cost to treat a hospitalized patient with the virus is $30,000, according to an estimate from America’s Health Insurance Plans, a trade group for insurers. While that tab would be partially picked up by insurance, exactly how much a Medicare beneficiary pays depends on their specific coverage.
Original, or basic, Medicare consists of Part A (hospital coverage) and Part B (outpatient care and medical equipment). Each of those come with costs.
Most people pay no premium for Part A due to their history of paying into the system through payroll taxes. However, it comes with a $1,408 deductible for each benefit period, as well as potential copays if you remain in the hospital beyond 60 days. Part B has a standard premium of $144.60 for 2020 (higher earners pay more) as well as a $198 deductible and, like Part A, cost-sharing (typically 20% of covered services).
Additionally, basic Medicare comes with no cap on out-of-pocket spending. Nor does Part D, which is prescription drug coverage.
In the Healthcare.com survey, 89% of respondents said prescription drugs are too expensive. Most of them (64%) spend under $50 a month in that category.
If your income is low enough to qualify, you may be able to dually enroll in both Medicare and Medicaid. Others may have retiree or workplace coverage that helps cover some costs.
For many beneficiaries, though, the options to mitigate potential expenses involve turning to private insurers that operate within the Medicare world.
With an Advantage Plan, you may have no premium or a low one, but you could have higher out-of-pocket costs like deductibles and copays. With Medigap, it’s the premiums that can be costly.
Mary Johnson
analyst with The Senior Citizens League
About a third of Medicare’s 62.5 million beneficiaries choose to get their Parts A and B benefits delivered through an Advantage Plan (Part C), which typically includes Part D coverage. Those plans, offered by private insurance companies, may or may not have a premium on top of what you pay for basic Medicare. They often include extras like dental, hearing and vision coverage.
Other beneficiaries instead add a standalone Part D plan to their Parts A and B coverage, as well as a Medicare supplement plan — aka “Medigap.”
Like Advantage Plans, these policies are sold by private insurers. They cover some of the out-of-pocket costs associated with basic Medicare. The monthly premiums can vary wildly from place to place and reach several thousand dollars per year for some policies.
The American Association for Medicare Supplement Insurance recently looked at the highest- and lowest-cost Plan G policies in various markets — and the variance can be stark due to differences in how insurers price their policies. For instance, it found that in one Dallas ZIP code, the lowest cost was $99 per month for a 65-year-old female and the highest was $381 monthly for that same consumer.
“With an Advantage Plan, you may have no premium or a low one, but you could have higher out-of-pocket costs like deductibles and copays,” Johnson said. “With Medigap, it’s the premiums that can be costly.”
The healthinsurance.com survey also showed that about 35% are worried about surprise medical bills if they contract Covid-19. This can happen when you go to a hospital that takes your insurance (or is in-network) yet a doctor or other provider that tends to you has no agreement with your insurer and bills you for the full amount at their full rate.
At the same time, some Advantage Plans have waived the cost of treating Covid-19, at least temporarily.
More than 6 million Medicare beneficiaries lacked any extra coverage in 2016 beyond Parts A and B, according to research from the Kaiser Family Foundation. The nonprofit noted that this puts those individuals at greater risk of incurring high medical expenses or foregoing medical care due to cost.
