Is Basic Medicare Coverage Enough? | eHealth (2024)

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Is Basic Medicare Coverage Enough? | eHealth? ›

Basic Medicare Coverage: Is That Enough? Summary: Original Medicare coverage generally has no out-of-pocket maximum and doesn't cover important things like prescription drugs. Additional coverage from private insurance companies can help meet your health-care needs.

You can get a Medicare Supplement Insurance (Medigap) policy to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. You can't buy and don't need Medigap.

Medicare doesn't typically cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket costs including copayments, coinsurance, and deductibles. As you'll learn in this article, Original Medicare (Part A and Part B) costs can really add up.

Supplemental insurance is advisable for those with Medicare to help cover out-of-pocket costs and gaps in coverage, offering financial protection for deductibles, coinsurance, and other medical expenses not fully covered by Medicare.

Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other health care facilities. Original Medicare doesn't cover some benefits like eye exams, most dental care, and routine exams. Plans must cover all medically necessary services that Original Medicare covers.

With Original Medicare, you can:

Go to any doctor or hospital that takes Medicare, anywhere in the U.S. Find providers that work with Medicare. Join a separate Medicare drug plan (Part D) to get drug coverage. Buy a Medicare Supplement Insurance (Medigap) policy to help lower your share of costs for services you get.

There's no limit on out-of-pocket costs in Medicare (Part A and Part B). Medigap plans can help reduce the burden of out-of-pocket costs. Out-of-pocket limits for Medicare Advantage plans vary depending on the company selling the plan. Medical care can be expensive, even when you're covered by Medicare.

If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctor's services you get while you're in a hospital.

On January 1, 2024 the asset test to qualify for a Medicare Savings Program was eliminated. This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles.

What is the best Medicare package? ›

Tens of thousands of Medicare Advantage beneficiaries in California, for instance, had to scramble to switch their insurance or their providers when health care system Scripps Health announced that two of its medical groups would no longer take Medicare Advantage in 2024.

Each type of plan offers a distinct set of benefits, which means that the average costs differ. For example, the average Medicare Part B premium is $164.90 per month for 2023, while the average cost of a Medicare supplemental plan with wider coverage, like Plan G, is typically much higher.

In some cases, your doctor may not agree with your insurance provider's decision to approve a less expensive treatment before paying for a more expensive one that your doctor may recommend. Providers in Medicare Advantage networks may also have to take time away from patients to spend it on pre-authorization paperwork.

What Does Medicare Part C Cost? Medicare Part C plans generally have lower premiums than Medigap plans. This is because you are agreeing to treat in the plan's network and pay copays as you go. The network may be an HMO network, where you'll need to choose a primary care physician and get referrals.

In 2021, Medicare Advantage covered nearly half of all Medicare beneficiaries (47%), or 27.6 million people with Medicare. (The number and share of Medicare Advantage enrollees has increased since 2021, up to 30.8 million in 2023, or 51% of all eligible beneficiaries.)

Medicare supplement insurance, also known as Medigap, covered 2 in 10 (21%) Medicare beneficiaries overall, or 41% of those in traditional Medicare (12.5 million beneficiaries) in 2021.

You can have group health plan coverage or retiree coverage based on your employment or through a family member. After the coordination period ends, Medicare pays first and your group health plan (or retiree coverage) pays second.

For many, supplemental health coverage can be a cost-effective way to help with out-of-pocket costs. Here are a few of the advantages to supplemental health insurance plans: They typically come with affordable monthly premiums. They can offer financial support when you experience unexpected medical situations.