Does Having Only Original Medicare Ever Make Sense?
You can choose to have only Original Medicare — Part A and Part B — without any supplemental coverage. But your overall out-of-pocket costs may be more expensive than the savings from the premiums you would pay for Medicare Advantage, Medigap and other supplemental plans.
- Written by Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
- Edited ByLamia Chowdhury
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.Read More
- Reviewed ByChristian Worstell
Christian Worstell is a licensed health insurance agent and an established writer in the sector, with articles featured in Forbes, MarketWatch, WebMD and more. His work has positively impacted beneficiaries nationwide and empowers them to make strong health care decisions.Read More
- Published: January 13, 2023
- Updated: January 17, 2023
- 7 min read time
- This page features 8 Cited Research Articles
- Edited By
- About one in five people enrolled in Original Medicare have no supplemental insurance.
- Original Medicare beneficiaries without supplemental insurance pay an average of 31% higher out-of-pocket costs than those with some type of supplemental coverage.
- Original Medicare does not cover most prescription drugs — which have risen faster than the overall rate of inflation between 2016 and 2022.
Can You Rely on Original Medicare Alone?
Relying on Original Medicare alone — without any supplemental insurance — can be a costly financial risk.
Some people may choose this option if they can’t afford higher premiums. But it tends to cost more in the long run with higher overall out-of-pocket costs. And a sudden major medical condition or accident could make it an expensive choice.
Original Medicare — Medicare Part A and Part B — covers basic medical and hospitalization costs. These include doctor visits, hospitalization and several related services and items.
But Original Medicare doesn’t cover every health care need and requires you to share the cost of the care you receive.
- Part A deductible — $1,600 in 2023
- Part B deductible — $226 in 2023
- Copays and coinsurance (typically 20% after meeting your deductible)
- Monthly Part B premium
- Full cost of prescription drugs (with very limited exceptions)
- Inpatient hospital coverage copays beyond 30 days
Without supplemental insurance, there is no limit on out-of-pocket expenses you might have to pay.
For instance, if you have heart surgery that costs $100,000 — you could be on the hook for $20,000 or more in out-of-pocket costs.
Medigap — also known as Medicare Supplement insurance — covers most out-of-pocket costs if you have Original Medicare. You can also add a Medicare Part D plan to help cover the costs of prescription drugs.
There are several different coverage combinations available to Medicare beneficiaries so it’s important to determine which one may be the most cost-effective for your particular needs.
Medicare Advantage is another option to help with out-of-pocket costs. These plans replace Original Medicare and usually provide prescription drug coverage along with other benefits that Original Medicare does not include.
Medicare Advantage plans have varying maximum out-of-pocket (MOOP) limits, but it tops out at $8,300 in 2023.
Candidates for Original Medicare Alone
Having only Original Medicare alone may be an option for Medicare beneficiaries with limited income who cannot afford higher premiums for supplemental insurance. But this could still leave you open to higher out-of-pocket costs.
For a 65-year-old couple retiring in 2022, total retirement lifetime health care costs are estimated to be $673,587, according to an analysis by HealthView Services.
Going with Original Medicare alone — without some type of supplemental Medicare insurance — not only exposes you to potentially high medical bills. It also exposes you to a late enrollment penalty if you later choose to add Medicare Part D prescription drug coverage.
If you miss your Medigap open enrollment period, you may also find it difficult, more expensive or impossible to get a Medigap plan if you change your mind later on.
But some people still choose to go without any supplemental insurance.
A 2021 analysis by the Kaiser Family Foundation determined that only about 90% of Medicare beneficiaries either had Original Medicare with some type of supplemental insurance — Medigap, Medicaid or employer-sponsored insurance — or had a Medicare Advantage plan in 2018. Medicare Advantage plans have a degree of built-in supplemental insurance.
But among people with Original Medicare, nearly one in five had no supplemental coverage.
People with no supplemental coverage generally spend the least on premiums — $1,697 per year. But the most on total out-of-pocket costs — $7,473 per year — according to the Kaiser Family Foundation analysis. That’s 31% more than the average out-of-pocket costs for people on all forms of supplemental insurance.
When Adding Supplemental Coverage Makes Sense
Adding supplemental coverage makes sense if it will reduce your out-of-pocket costs — including premiums, copays, coinsurance, deductibles and prescription drug costs.
The best plan or combination of plans depends on your health care needs.
Adding Medicare Supplemental Insurance (Medigap)
Medigap can be added to Original Medicare. It covers most of your out-of-pocket costs associated with Medicare.
It makes sense if you plan to travel. Most plans partially cover emergency medical services abroad. And all plans cover services anywhere in the United States so long as the doctor, hospital or other health care provider takes Medicare.
Medigap won’t give you many additional benefits. It cannot be used to cover anything that is not covered under Medicare Part A and Part B already.
Adding Medicare Part D Prescription Drug Coverage
If you have a lot of prescriptions — or expensive prescriptions — it may make sense to add Medicare Part D prescription drug coverage.
Prescription drug prices have been rising faster than the overall inflation rate in recent years, according to the U.S. Department of Health and Human Services. HHS tracks the prices of 1,216 prescription drugs. It found that in a one-year period ending in July 2022, the average inflation rate for these drugs was 31.6% — compared to the overall 8.5% inflation rate.
Original Medicare and Medigap do not cover prescription drugs you take at home. Medicare Part D plans can reduce what you pay out-of-pocket for medications. But you should check a plan’s formulary to make sure your medications are on the list — or if there is a substitute on the list you can take instead.
Replacing Original Medicare With Medicare Advantage
Medicare Advantage plans may be an attractive alternative to Original Medicare if you don’t mind using doctors and hospitals in a limited network and want additional benefits. These may be a better option if you are in good health with no family or personal history of chronic or serious medical issues.
Medicare Advantage plans are private insurance policies designed to replace Original Medicare. They are required to cover everything Medicare Part A and Part B cover — but they typically provide more benefits.
Most plans come with Part D benefits built-in. Medicare Advantage plans may also cover hearing, dental and vision services along with other benefits.
You still have to pay Medicare Part B premiums in addition to any Medicare Advantage premium. But many Advantage plans have no premiums and some offer rebates — making them cheaper than Original Medicare premiums.
You can’t have a Medigap plan with Medicare Advantage plans, so your out-of-pocket costs can be much higher than Original Medicare with Medigap.
Frequently Asked Questions About Having Only Original Medicare
Editor Samantha Connell contributed to this article.
8 Cited Research Articles
- Bosworth, A., et al. (2022, September 30). Price Increases for Prescription Drugs, 2016-2022. Retrieved from https://aspe.hhs.gov/reports/prescription-drug-price-increases
- Freed, M., et al. (2022, August 25). Medicare Advantage in 2022: Premiums, Out-of-Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization and Star Ratings. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-premiums-out-of-pocket-limits-cost-sharing-supplemental-benefits-prior-authorization-and-star-ratings/
- U.S. Centers for Medicare & Medicaid Services. (2022, June). Items and Services Not Covered Under Medicare. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-and-Services-Not-Covered-Under-Medicare-Booklet-ICN906765.pdf
- Dhue, S. and Epperson, S. (2022, May 16). Americans Can Expect To Pay a lot More for Medical Care in Retirement. Retrieved from https://www.cnbc.com/2022/05/16/americans-can-expect-to-pay-a-lot-more-for-medical-care-in-retirement.html
- HealthView Services. (2022). Retirement Healthcare Costs Data Report Brief: The Long-Term Impact of Short-Term Inflation. Retrieved from https://hvsfinancial.com/wp-content/uploads/2022/03/HVS-Data-Report-Brief-0312222.pdf
- Cubanski, J., et al. (2019, November 4). How Much Do Medicare Beneficiaries Spend Out of Pocket on Health Care? Retrieved from https://www.kff.org/medicare/issue-brief/how-much-do-medicare-beneficiaries-spend-out-of-pocket-on-health-care/
- O’Brien, S. (2019, June 9). Considering Basic Medicare With No Backup Insurance? That Could Be a Costly Mistake, Experts Say. Retrieved from https://www.cnbc.com/2019/06/07/considering-basic-medicare-with-no-backup-insurance-is-a-big-mistake.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Part A Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers
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