Reader questions about Medicare

After a column I wrote last summer about Medicare and the various Medicare for All proposals floating around, I was inundated with questions and comments. With Medicare Open Enrollment season upon us (Oct. 15-Dec. 7), it’s a good time to address some additional reader concerns.

George from Virginia: “When Medicare for All is talked about, it is made to sound like it is free. What would the bottom-line cost be to me?”

Answer: There is no free lunch, especially when it comes to health care and insurance. When politicians talk about the cost of “Medicare for All” being cheaper for the vast majority of Americans than their current coverage, they are not breaking it down and preparing us for what would likely occur: The cost of insurance and co-pays would likely drop, but taxes would rise. The hope is that net-net, most people would be better off.

Sharon from Oregon: “I had sticker shock when I learned about the cost of Medicare. It might be helpful if you could break it down for readers.”

Answer: At the time of this writing, the 2020 numbers were not available, but here’s what the breakdown was for 2019:

Part A (Hospital): Typically, there is no premium charge, but there is an annual deductible of $1,364.

Part B (Medical): The monthly premium amount is at least $135.50 (up to $460.50, depending on income). There is also an annual deductible of $185, and most beneficiaries will have 20% co-pays.

Part C (Medicare Advantage): Premiums and co-pays vary.

Part D (Prescription drug coverage): Premiums and deductibles vary.

Higher earners must pay 85% of the cost of their Medicare Parts B and D benefits, while those beneficiaries with incomes of $85,000 or less ($170,000 for couples) pay 25% of the cost of their benefits.

Bill from New York: “What’s the rationale behind Medicare NOT covering eye exams or glasses?”

Answer: The Medicare website puts it plainly: “Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself.” In other words, it’s just too expensive for Medicare to cover the following: long-term care (also called custodial care); most dental care; eye exams related to prescribing glasses; dentures; cosmetic surgery; acupuncture; hearing aids and exams for fitting them; and routine foot care.

You can purchase other insurance that covers these services or a Medicare health plan that covers them, but doing so will add to your total annual costs for health care.

Barbara from Illinois: “I’m 64 and was offered an early retirement package. I am inclined to take it, but what are my options for insurance between now and age 65?”

Answer: If your spouse is still working, you can switch to that coverage, but if you are single, you may want to consider COBRA, which will give you the exact same coverage that you currently have, but it is expensive. Alternatively, you can investigate the Affordable Care Act, which offers a variety of options, but the plans available may not be as robust as your current coverage. If you qualify based on low income, you may be able to get federal tax credits that make ACA coverage more affordable.

Jill Schlesinger, CFP, is a CBS News Business Analyst. A former options trader and CIO of an investment advisory firm, she welcomes comments and questions at askjill@jillonmoney.com.