If your income is very low, you may not need more health insurance than Medicare. Low-income individuals who are eligible for Medicare may also qualify for Medicaid – a joint federal and state low-income assistance program. For people who have both, Medicaid will pick up where Medicare coverage leaves off. Full Medicaid beneficiaries can receive dental, vision, long-term care, and other services Medicare does not cover, in addition to coinsurance and deductibles they would otherwise have to pay out of pocket.
Some Medicare beneficiaries receive union or employer-sponsored benefits to supplement their coverage, and public programs are available for low-income beneficiaries. But for the remainder, it might not be advisable to rely on original Medicare alone to cover all of your healthcare costs.
What Risks Do You Face With Original Medicare Alone?
The main risk with original Medicare is there is no cap on out-of-pocket expenses. If you have a serious illness that requires a lengthy hospital stay, your out-of-pocket costs could be astronomical. To prevent major expenses in the event of serious health issues, you may need to purchase a Medigap plan. This is supplemental health insurance sold by private companies and intended to help fill the gaps left by original Medicare.
In addition, Medicare Parts A and B do not cover outpatient prescription drugs. If you want coverage, you need to purchase a Part D plan through a private insurance company. You pay premiums, plus copays or a percentage of the cost, along with an annual deductible in some cases. In 2020, after the total cost of your drugs reaches $4,020, your responsibility for the cost is reduced to 25% for the remainder of the year. If your cost alone for prescription drugs reaches $6,350, you will only be responsible for 5% of the cost of medications.
What About a Medicare Advantage Plan?
If you are enrolled in Medicare Parts A and B, you have the option to choose a Medicare Advantage Plan (Medicare Part C) for your healthcare coverage. These health plans, typically HMOs or PPOs, are approved by Medicare and sold by private insurance companies. They are required under the Affordable Care Act to set an annual dollar limit on out-of-pocket expenses, which cannot exceed $7,550 in 2021, although the limits are typically much lower.
Many Medicare Advantage Plans provide dental, vision, and prescription drug coverage, and some provide hearing coverage. Some Medicare Advantage Plans are “zero premium,” meaning you pay nothing for premiums beyond what you are already paying for Part B. The average cost is low among plans that do have a premium. Some plans have a deductible, while others do not.
Most people enrolled in a Medicare Advantage Plan pay a copay, usually $10 to $20 for doctor visits and $75 or less for urgent care and emergency room visits. Many plans have a tiered copayment system for prescription drugs, with a $3 to $5 range for generics and higher copays for specialty and name-brand drugs.
You are less likely to need additional insurance with a Medicare Advantage Plan than you would be with original Medicare. Our experienced agent can help you choose a plan that is right for you.