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Is Basic Medicare Coverage Enough for my Parents ?

Summary:

Traditional Medicare, Part A and Part B, provide basic medical coverage. But be aware that:

  • Medicare doesn’t cover every service your parents may need – it doesn’t cover most prescription drugs you take at home, for example.
  • Medicare does come with out-of-pocket costs. You’ll pay a deductible amount for many services, and/or coinsurance or copayments.
  • Medicare doesn’t limit your out-of-pocket costs. If you’re hospitalized for several months, for example, your costs could get very high.

Medicare coverage is new for my parents                   

My parents are conventional. No sushi for Dad: he’s a steak-and-potatoes guy. And Mom prefers to do her banking in person. She shudders at the thought of a banking app on her phone. It’s time for them to enroll in Medicare. Predictably, they are inclined to enroll in basic Medicare. But is this sufficient coverage? It’s likely the answer is “no” when it comes to my parents.

What basic Medicare coverage means

It’s good for Mom and Dad to know what basic Medicare (Part A and Part B) covers. Start with Medicare Part A. It typically helps pay the costs of:

  • Inpatient hospital care
  • Skilled nursing home care
  • Inpatient rehabilitation care
  • Home health care if you are homebound and need skilled care after an inpatient hospital stay
  • Hospice care if you are terminally ill and your doctor certifies you need this care.

This isn’t a complete list of what Part A may cover.

Medicare Part B helps pay for medical and outpatient services. Medicare Part B covered services generally include:

  • Doctor visits
  • Lab work, x-rays, and scans
  • Speech, physical, and occupational therapies
  • Durable medical equipment such as walkers, wheelchairs, and oxygen tanks
  • Ambulance services to and from the hospital in an emergency
  • Outpatient hospital or clinic care
  • Certain medications, usually administered by a physician or in a doctor’s office, such as anti-cancer medications and certain vaccines

This isn’t a complete list of what Part B may cover.

Are there limits to basic Medicare coverage?

There are limitations to Original Medicare coverage. Help your parents understand the impact Medicare coverage limits could have on their budget.

Medicare coverage of prescription drugs

For example, Medicare Part A and Part B doesn’t cover most prescriptions you take at home. That’s why basic Medicare coverage, Part A and Part B, wouldn’t be enough to cover my parents’ out-of-pocket Medicare costs. Mom and Dad both take several medications.

Medicare Part D is optional prescription drug coverage you can get in either of two different ways.

Both types of plans are available from private insurance companies that contract with Medicare.

Medicare cost-sharing

Usually Medicare Part A and Part B don’t pay the full cost of covered services. Your parents will have to pay their portion of the Medicare-covered services they receive. Typical out-of-pocket costs are Medicare deductibles, coinsurance and/or copayments.

Let’s say your parents visit the doctor. First, they’ll each have to pay their Medicare Part B annual deductible (In 2019 this is $185). Then they will pay 20% of the Medicare-approved amount for most Medicare Part B covered services.

Hospital stays can get expensive – that’s where Medicare Part A comes in. If your mother is an inpatient, she’ll have to pay her Part A deductible ($1,364 in 2019). After that, she’ll usually have Part A coinsurance to pay:

  • 1-60 days: $0 per day
  • 61-90 days: $341 per day in 2019
  • 91 days or more: $682 per day in 2019 for each “lifetime reserve day.” You get a total of 60 lifetime reserve days.

The Part A deductible and coinsurance apply for every benefit period. A benefit period starts when you’re admitted as an inpatient, and ends when you haven’t had inpatient care for 60 days in a row. So if Mom winds up in the hospital again a few months later, she’d have to pay the deductible again, and coinsurance as listed above.

There are certain things Medicare Part A and Part B don’t cover. Emergency care outside the United States isn’t covered in most cases. Routine dental, vision, and hearing care are typically not covered services.

Medicare Supplement (Medigap) insurance plans for gaps in Medicare coverage

A Medicare Supplement insurance plan for each of your parents may be a worthwhile safety net, protecting them from some limitations to Medicare coverage. Medicare Supplement insurance is designed to work alongside Medicare Part A and Part B. Medicare Supplement insurance plans may help pay Original Medicare deductibles, copayments, and coinsurance.

Medicare Supplement plans are sold by private insurance companies. They offer standardized benefits. This means Medicare Supplement insurance plans are consistent no matter which insurer who sells them. In most states, up to 10 types of Medicare Supplement plans are available. Each type is clearly labeled by letter. So, for example, Medicare Supplement Plan G has certain basic benefits anywhere you buy the plan.

You can find these standardized types by using this Medicare Supplement comparison chart. If you see a plan that you think will fit your mother’s or father’s needs, you can start comparing plan prices in their state right away. Just enter your parents’ zip code on this page and click the Medicare Supplement tab to get started.

Keep in mind that your Mom and Dad each have to have their own Medicare Supplement insurance plan, if that’s what they decide they want. Spouses can’t share a single policy.

Learn more about Medicare coverage options

You can find out more about the Medicare coverage options available where your parents live. Just enter their zip code on this page, and then click the tab you’re interested in.

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