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.

Definition 

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: 

1. Medicare part A – hospital insurance; 
2. 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. 

Advantages 

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. 

Disadvantages 

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.