I start Medicare this year. I read articles talking about how healthcare in retirement will cost $250K +. How does that happen if you're on Medicare? I understand a specialist not accepting Medicare would be expensive.
My premiums including prescription drugs will be @ $280/month. I really don't expect to live past 95. That's $100,800 for premiums alone for 30 years. What are these extraordinary health expenses? I'm asking about OOP expenses that might be expected.
Many have mentioned Long term care and dental and vision. Also, hearing aids aren't covered. DH recently got hearing aids and paid about $2k for the hearing aids and accessories (note: getting these at Costco was far cheaper than other alternatives).
There are a few other things that may or may not be important. There are things that Medicare simply doesn't cover or limits. So you can't get an annual physical with Medicare. They can't just do full lab panels. Last year, for example, my doctor ran some lab work on me and one test was an A1C. I am not diabetic. Medicare disallowed it. Now since the lab accepted Medicare assignment, I didn't have to pay it. The doctor though had originally wanted me to use a different lab where I would sign in advance to pay anything Medicare didn't pay. I refused to do it so they sent the lab work to Lab Corp. However, it is possible that I might want some lab work Medicare wouldn't pay for and I might pay out of pocket for that.
Years ago, when my father was dying he was in the hospital for months (complications from surgery) and he was getting close to the maximum time period Medicare would pay. After that it would have been considered long term care and not covered even though he wasn't in a skilled nursing facility. He actually needed to be in a full hospital.
In some parts of the country it can be hard to find good primary care doctors that you can get into see in a reasonable period of time. On Medicare I've never had trouble finding specialists and they've all taken Medicare. Lots of primary care doctors do not do so or you have to wait months for an appointment. I know a lot of people who do pay for a concierge doctor (in many cases this will include the cost of an annual physical).
IF we have no medical catastrophe. But the lack of an OOP max with TM (or a 'true' OOPmax with MA) is (to use the OP's words) is a big feature where Medicare 'falls short'.
If the claim is covered by Medicare then my Plan G does pay all the rest. So in that since where it has a OOP Max doesn't matter. Now for some things, Medicare does limit for how long they provide coverage.
Time2, your zip code makes a difference. And for some reason, I was offered an $11 drug plan that covers my meds. My total OOP cost for meds + premium (all generic) is $92/year. Of course, that could change very quickly. My broker said I could change my drug plan every year if I wanted to. So, say I had to take an expensive med not offered on that plan, I could upgrade to a plan that covered it.
Zip code makes a difference for your supplement and for the Part D plan. The Part B premium ($170.10) does not vary with Zip code.
Oh - another thing that makes a difference. Most drug plans have a deductible of $480. Sometimes generics are covered without regard to the deductible. The bigger issue is what the copayment is for Tier 3 (preferred brand name drugs) and Tier 4 (non-preferred brand name drugs). Tier 4 drugs often have a very long percentage co-payment of 40% or 50%. That can be a lot of money. Also, most drug plans simply don't cover lots of brand name meds. They will always cover something for the condition in my experience but they may not cover the specific med your doctor wants you to take.
Also, if a drug is very expensive and it is a Tier 3 drug and your co-payment is low then the part paid by the insurer is high and they amount they pay can lead you into the donut hole pretty quickly. My doctor prescribed a medication for me that is several hundred dollars a month. My co-pay (after deductible) was only $35. Now, I only took this med a few months so it was fine. But if I had taken it for much longer it would have knocked me into the donut hole and my costs would have gone way up.
All of that is not a big issue for me since I don't take a lot of meds. During my mom's last few years of life prescription meds were a huge expense for her even with the Part D coverage as she was on so many meds.