Did you know that 81% of Medicare beneficiaries have additional supplemental coverage like Medicare Part D prescription coverage, Medicare Advantage, or a Medigap plan?
While some Medicare beneficiaries find that Original Medicare is adequate to cover their medical expenses, the overwhelming majority of Americans choose additional health coverage.
This article will tell you everything you need to know to determine whether you should seek additional health insurance.
When Original Medicare Is Enough
There is one notable situation in which having traditional Medicare covers everything you need, and no supplemental insurance is necessary. If you are a low-income individual, you may be eligible for both Medicare and Medicaid. Here, any medical bills not paid for Original Medicare coverage will be paid by Medicaid.
While Medicare is a federal government program that provides health insurance to Americans over 65 and those with specific disabilities, Medicaid services are funded jointly by federal and state programs to assist low-income individuals by paying for their health care.
When all of your medical expenses and prescription drug coverage is paid for by a combination of Original Medicare and Medicaid, there is no need to purchase Medicare supplement plans. You may also be eligible for a Medicare Savings Program, which can also negate the need for additional coverage.
When Original Medicare is Not Enough
To decide whether you can get by with Original Medicare or you should begin shopping for a Medicare Advantage plan or other medical insurance, it can be helpful to understand what Medicare doesn’t cover. This knowledge can help you make a rational and informed decision about your medical insurance.
Medicare has four parts, and two of those parts are known as Original Medicare. A brief outline of coverage is as follows:
- Medicare Part A (Original Medicare): Known as hospital insurance, Medicare Part A pays for hospital stays, skilled nursing facilities, and related services. Most Medicare beneficiaries do not pay for Medicare Part A, though there could be a deductible for hospital stays and additional costs for visits that exceed 60 days.
- Medicare Part B (Original Medicare): Part B is the workhorse portion of Medicare plans, providing Medicare beneficiaries with what is commonly known as health insurance. Medicare Part B provides coverage for outpatient services, including doctor visits, screenings, medical equipment, outpatient surgical care, physical therapy appointments, and mental health.
- Medicare Part C: Also referred to as Medicare Advantage, this coverage is purchased through private insurance companies. While each Medicare Advantage plan is different, most provide coverage for prescription drugs, as well as dental and vision coverage. Other medical services may also be part of the benefits allowed for by the insurance company.
Most notably, all Medicare Advantage plans stipulate an out-of-pocket maximum for annual medical expenses, which can give you peace of mind if you are struck with a long-term health issue.
- Medicare Part D: For Medicare beneficiaries looking for coverage for outpatient prescription drugs, Medicare Part D can be purchased through private insurance companies to function as a Medicare supplement.
Because Original Medicare covers only limited services, most people look for additional avenues to provide coverage for their medical care.
It’s a common misconception to think that basic Medicare will pay 100% of the expenses for outpatient services (Medicare Part B). However, only about 80% of those costs are covered, leaving Medicare beneficiaries with additional out-of-pocket costs for the balance. Some or all of those fees can be paid for by having Medicare supplement plans.
Why 81% of Americans have Additional Medicare Coverage
The 81% of Americans that opt for additional coverage utilize the following avenues:
- Health insurance from an employer or union
- Medigap plans
- Medicare Advantage plans
- Medicare Part D prescription drug coverage
Technically, anyone can choose to only have Original Medicare. The reason that most people are covered by a Medicare supplement or alternative is that not having enough coverage means paying more in out-of-pocket expenses. As we get older and healthcare costs rise, it can leave one financially vulnerable to skyrocketing medical costs if stand alone Medicare is one’s only health coverage.
Additional Medicare Coverage Options
If you don’t fall into a low-income category that makes you dual eligible for traditional Medicare and Medicaid and you prefer to limit out-of-pocket costs, you will likely want to supplement your Medicare coverage with one of the following options:
- Medicare Advantage: As a private insurance alternative, Medicare Advantage (also known as Medicare Part C) can pick up where traditional Medicare leaves off. These plans often provide a prescription plan to get coverage for prescription medications through your medical providers.
Most plans also provide additional medical services, including dental coverage, eye exams, and hearing checks. Wellness programs and gym memberships may also be included under this type of Medicare coverage.
- Medicare Part D: For people primarily concerned about the cost of prescription drugs, Medicare plans with Part D only offer Medicare supplement insurance through a prescription drug plan to help control out-of-pocket costs for medication.
Part D plans allow Medicare beneficiaries to pay for only a fraction of the cost of prescriptions, including those that treat cancer and HIV.
- Medigap: As mentioned above, Medicare doesn’t cover 100% of medical costs, and the difference between what Medicare pays for and what a beneficiary has to pay can be significant. This is where Medigap comes in. Medigap can literally bridge the gap between what traditional Medicare covers and what medical bills you have outstanding.
Medigap plans come in 10 different varieties and help cover the cost of coinsurance and deductibles. There is no prescription drug coverage under Medigap plans, however.
Once you’ve decided that basic Medicare will not be enough to satisfy your medical needs (including drug coverage) and you elect for Medicare supplement insurance, there are still some factors to figure out, including which Medicare supplement insurance is right for you.
When you have more than one type of health insurance, there are times when you’ll have Medicare as primary insurance and other instances where your supplemental coverage pays the bill.
A qualified Medicare advisor can help you navigate your choices while ensuring you don’t miss out on Medicare open enrollment.