Medicare without supplement can be a cause for concern, depending on your overall health and well-being. A Medicare supplemental policy is designed to provide a more comprehensive health insurance coverage that reduces your out-of-pocket medical expenses and minimizes unpleasant surprises when you see your healthcare bills.
Still, there’s a reason why supplemental policies are just that – supplemental. Not everyone needs them, and it might be a waste of money for you to apply for them. However, it’s important to know that Original Medicare – Parts A and B – will not fully cover all of your medical bills, so looking into a supplemental policy is something we suggest.
You should always consult an experienced agent on the best insurance packages for you, but you should also be somewhat familiar with your potential options beforehand. Therefore, let’s go over your Medicare insurance options and find the answer to the burning question – what is Medicare without supplement?
Medicare Without Supplement
Approximately 18% of Americans receive health coverage through Medicare. It’s the largest provider of medical insurance in the US, available to senior citizens over the age of 65 and younger individuals with disabilities like Lou Gehrig’s disease (ALS) and End-Stage Renal Disease (ESDR).
Medicare without supplement coverage is a comprehensive insurance plan offered by the national government. It subsidizes the major healthcare costs you might encounter in most circumstances, but it does have some gaps. It’s important you know the answer to why is medicare supplement insurance important.
Medicare was first introduced in 1965 as part of the Social Security Act, which aimed to offer insurance to older, retired individuals without employee coverage. Today, its eligibility criteria are less stringent, and the program is available to:
- Those over 65 with 40 work credits;
- Those over 65 whose spouse has 40 work credits;
- Certain younger people with disabilities;
- Those with ESDR or ALS.
Those who have fewer than 40 work credits (acquired by working and paying social security taxes) can still apply for Medicare, although their premiums might be higher.
Currently, the program is run by the Centers for Medicare and Medicaid Services and receives funding from the federal budget, social security and income taxes, and partially from premiums covered by the beneficiaries.
As a federal insurance program, Medicare offers coverage for an array of healthcare situations. The plans are somewhat customizable, and their premiums can vary based on your income, current conditions, and more.
However, considering how extensive the Medicare program can be, it can be confusing to the beneficiaries, so let’s see exactly what it covers and its advantages and disadvantages.
What It Covers
Medicare without supplement plans is commonly referred to as Original Medicare. It offers two insurance options:
- Medicare part A – hospital insurance;
- Medicare part B – medical insurance.
As a type of hospital insurance, Medicare part A offers coverage for most in-patient healthcare needs. Depending on the national and state laws, as well as coverage decisions made by Medicare companies in your area, part A will provide coverage for:
- In-patient care in a hospital;
- Hospice care;
- Nursing home care;
- Nursing facility care;
- Home health care.
Medicare part A will include coverage for food, semi-private rooms, nursing services, and most types of lab testing and analyses.
You can be eligible for Medicare part A if you have enough work credits, if your spouse has enough work credits, or if you have a specific disability.
Medicare part B offers medical and preventive services coverage. As is the case with part A, the exact coverage options will depend on federal and state laws and your local Medicare company. Still, you should receive coverage for:
- Medical equipment (wheelchairs, walkers, etc.);
- Ambulance services;
- Physical therapy;
- Clinical research;
- Mental health services (in- and out-patient care, partial hospitalization);
- Limited prescription drugs.
Most preventative services under part B will be free of charge to the beneficiaries as long as you get them from a health care provider that’s part of the Medicare network.
Original Medicare health care insurance plans offer an array of benefits that you can enjoy. Some of the advantages are:
- Relatively low premiums;
- Broad eligibility criteria;
- Broad acceptance across all 50 states;
- Coordinated medical care.
As long as you’re a legal, permanent resident of the U.S. and over 65 years old, or under 65 with a disability, you could be eligible for Original Medicare. You might not even have monthly premiums and still receive excellent coverage in some instances.
Furthermore, over 93% of primary health care providers accept Medicare, meaning you’ll have no shortage of options when it comes to choosing your primary care doctor. You could receive coverage in all 50 states and also Puerto Rico, U.S. Virgin Islands, American Samoa, Guam, and the Northern Mariana Islands.
Of course, no insurance plan is perfect, nor is it equally suitable for all beneficiaries. Original Medicare has some disadvantages that you’ll want to keep in mind before applying:
- No vision, dental, and hearing coverage;
- No prescription drug coverage;
- Potentially high out-of-pocket expenses;
- Limited choice of health care providers;
- No coverage outside the U.S. and some of its territories.
If you have vision, dental, or hearing problems, Original Medicare might not be suitable for you as it provides no coverage for them. You’ll either have to pay for vision, dental, and hearing care out of pocket, or you’ll need to use supplemental plans to cover for it.
While Medicare part B does cover some prescription drugs, the list is somewhat limited, and you’ll likely need to pay a higher price for most prescriptions that you need. The costs can quickly add up if you rely on daily medication.
Perhaps the most significant disadvantage is that your out-of-pocket expenses could easily increase depending on your condition. There’s no cap on your out-of-pocket costs. You could have high deductibles and co-insurance costs with part A, and part B typically covers only up to 80% of the cost of the covered services. The remaining 20% could pose problems.
In most instances, the advantages of the Original Medicare without supplement plans far outweigh the disadvantages. Still, it’s in your best interest to consult your primary care provider and an expert insurance agent before you make your decision.
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Is Medicare Without Supplement Enough?
Whether Original Medicare is enough depends entirely on you, your unique medical condition, and your preferences. Part A and part B offer excellent coverage for the average enrollee who meets the eligibility criteria.
Still, only about 17% of all Medicare beneficiaries rely solely on Original Medicare. With no caps on out-of-pocket expenses, no coverage for vision, dental, and hearing care, and no coverage for prescription drugs, Original Medicare might not be enough to minimize your healthcare expenses truly.
When is Medicare Supplement Insurance a Necessity?
Medicare supplement insurance plans, also known as Medigap, are necessary when you need the extra coverage that’s not offered through the Original Medicare.
Medigap plans are offered through private insurance companies and have varying standardized coverage options. In most instances, they help cover the costs such as copayments, deductibles, and coinsurance – things that the Original Medicare doesn’t cover.
There are ten Medigap plans – plan A, plan B, plan C, plan D, plan F, plan G, plan K, plan L, plan M, and plan N (with high-deductible plan F and plan K available). Each plan offers unique benefits, so it’s in your best interest to consult your insurance agent to find the plan most suitable for you.
Keep in mind that Medicare supplement plans, aka Medigap, aren’t the same as Medicare Advantage, known as Medicare part C. You cannot have both Medigap and Medicare Advantage, so you’ll need to scrutinize your options carefully.
How Much Does Medicare Without Supplement Cost?
Your Original Medicare costs will largely depend on the number of work credits you have and your income.
The premium for part A can be:
- Free (with 40 work credits);
- Up to $274 (for those who paid Medicare taxes for 30 to 39 quarters);
- Up to $499 (for those who paid Medicare taxes for less than 30 quarters).
Deductible and coinsurance payments for part A can be:
- $1,556 deductible per benefit period;
- $0 coinsurance for in-patient hospital stay for up to 60 days;
- $389 coinsurance for in-patient hospital stay between 61 and 90 days;
- $778 coinsurance for in-patient hospital stays over 91 days.
The premium for part B can be:
- $170.10 or higher, depending on your income.
Deductible and coinsurance payments for part B can be:
- 20% of the Medicare-Approved Amount.
To find out exactly how much you’ll have to pay in premiums, coinsurance, and deductibles, you’ll need to consult your chosen insurance agent.
How Does Medicare Without Supplement Work With Other Insurance?
Original Medicare can be combined with other insurance plans, including Medicaid, group health plans, and the like. With multiple insurance plans, the coordination of benefits rules will determine primary, secondary, and potentially tertiary payers. Many people don’t know what is better between medicare vs medicaid.
The primary payer will pay the first chunk of your expenses (up to their coverage limits), the second (and tertiary) payer will cover the remaining costs, at least partially.
Keep in mind that you still might be responsible for some out-of-pocket costs, depending on the limits of your primary and secondary payers.
Is Medicare Without Supplement Worth It?
Whether Original Medicare is worth it will depend on you and you alone. As a general rule of thumb, it’s well worth it if you have enough disposable income to cover unpredictable out-of-pocket expenses. Also if you usually need insurance only for common health care situations – annual checkups, standard nursing services, infrequent in- and out-patient care.
However, if you need coverage for prescriptions, medical expenses in foreign countries, and other non-typical healthcare needs, you’ll likely have to use Medicare supplement plans or additional insurance.
Consult your doctor and insurance agents about Medicare and other insurance options best suited for you.
Where Can I Find Out More and Get Advice on Medicare Without Supplement?
Original Medicare and all Medicare supplement plans can be confusing. To learn more about them, how beneficial they are for you, and whether they’re the best option for you, consult our experienced agents at Policy Solver. Contact us or schedule a free consultation, and we will get connect with you soon!
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