When enrolling in Medicare, many new beneficiaries are under the impression that they’ll pay one premium for Medicare, and be set with full coverage.
Unfortunately, this is not the case. Original Medicare includes only Medicare Part A (Hospital Insurance) and Medicare Part B (Outpatient Insurance). Though Medicare Part B is optional, elective coverage, over 90% of Medicare beneficiaries opt to take Part B.
First, let’s dive a bit into what Original Medicare does cover, then we’ll explore the areas you may need supplementary coverage.
Medicare Part A
Medicare Part A is your hospitalization coverage. It covers your stay in a medical facility and the associated services while in that facility, such as: inpatient care in hospitals, inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, home health care services, hospice care, and more.
While Medicare Part A covers the majority of your medical expenses while in a medical facility, you will still be required to cover deductibles and coinsurance while in the hospital (if you have no supplementary coverage).
Medicare Part B
Medicare Part B is your outpatient medical coverage for services that are deemed either medically necessary or preventive. Part B benefits include ambulance services, outpatient care, clinical research, and durable medical equipment.
If you do not have a Medicare Supplement plan, there are a variety of medical expenses that you may be left exposed to.
What Medicare Doesn’t Cover
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have additional insurance.
If Medicare covers a service or item, you generally must still pay your deductible, coinsurance, and copayments, unless you have a Medicare Supplement plan that covers them.
Below, we’ll cover 3 main gaps in your Medicare coverage, as well as a helpful tool for each gap to ensure you get proper coverage in every area.
Part D Prescription Drug Coverage
Your first gap in Medicare is your prescription drug coverage. This is not covered by Original Medicare Parts A & B.
Medicare Part D is your prescription drug coverage, and helps cover the cost of prescription drugs. While it is not included in your Original Medicare (Parts A & B), Part D is available to any individual with Medicare Parts A & B, and each Part D plan covers its own list of covered drugs that is subject to change at any time.
Dental, Vision and Hearing Coverage
The second gap in Original Medicare is your dental, vision, and hearing coverage. Medicare does not cover your typical dental, vision, and hearing exams and expenses, nor does Medicare supplement insurance.
Because of this, you’ll need a separate plan to ensure you have healthy teeth, eyes and ears.
Our Dental, Vision, and Hearing plan can combine the deductible for all three services, and covers many of the typical preventive checkups and services you need for as low as $31/month (costs vary by area and other circumstances).
Your third gap in Medicare is your exposure to the Parts A & B deductibles, coinsurance and excess charges. Though Medicare covers most of your medical services at Medicare providers, your exposure will be a deductible for Part A, a deductible for Part B, possible 15% excess charges, and a 20% coinsurance for all medical expenses after your meet your Part A and B deductibles (this will be your biggest financial exposure).
In the case of a major-medical event, you could owe tens of thousands of dollars in medical expenses if you don’t have a Medicare supplement plan to help cover these costs for you.
A Medicare Supplement policy is a private insurance plan that helps to cover such things as the Medicare Part A deductible, 20% coinsurance, and excess charges. The plans are completely standardized by Medicare and are offered as plan letters with each plan offering different coverage for the different areas of exposure.
Though the most popular plans are Plan F, Plan G, and Plan N, the best Medicare supplement plan for you will vary based on a number of factors.
So, is Original Medicare enough for you? It’s going to depend on your tolerance for large out-of-pocket costs. Even if you are rarely ill and have very good health, you’ll want to be financially prepared should you have an unexpected surgery or medical procedure.
At GoMedigap, the two things we are most confident about are our extensive knowledge of Medicare supplement insurance, and our ability to provide excellent customer service to our clients. Our goal as a Medicare supplement agency is to empower you to understand and feel comfortable with your decisions regarding Medicare.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.