Is Original Medicare Enough for You?
Is Original Medicare Enough for You?
Original Medicare includes a wide range of medical services and treatments, but they do not cover everything that a person over 65-years of age may eventually require. Because the federal government is the one that provides it, it easy for recipients to assume that it offers comprehensive benefits. However, closer inspection of the actual needs of a senior will reveal that it only shoulders a portion of the potential medical expense one could be faced with.
This doesn’t mean that Medicare is a Band-Aid solution and is only meant to create a semblance of protection. For many people who are perfectly healthy, it is, indeed, sufficient but only until the unexpected may occur. The issue is that many people at age 65 are in need of ongoing medical care and this is why Medicare Supplement plans are offered by private insurers as add-ons.
What Original Medicare Includes
Before deciding if Original Medicare is enough for you, we have to first lay out what it does cover. There are four parts to the Original plan, with each responsible for a specific set of medical services.
Part A | Part B | Part C* | Part D |
Inpatient and hospital coverage | Outpatient and medical coverage | Also called Medicare Advantage, it is an alternative way of obtaining Medicare benefits and consists of different health plans regulated by Medicare itself but operated by private insurance companies (such as PPOs and HMOs) | Coverage for prescription drugs |
*Part C may only be obtained only if you already have Medicare Part A and Part B
HMO = Health Maintenance Organization; PPO = Preferred Provider Organization
More About Medicare Advantage
Medicare Advantage or Medicare Part C offers the same benefits as Part A and Part B, and most also cover Part D drug coverage in their packages. It is up to the insurance provider to decide how extensive its package will be and those who subscribe may or may not be asked to pay a monthly premium.
These plans are not available in all geographical areas and HMO’s typically require its members to visit only the hospitals and doctors that are listed in their networks to obtain full benefits, except when it is an emergency. Some PPOs allow members to seek services outside of the network but will charge higher copays. This is why Medicare advisors do not recommend this plan to people who do a lot of traveling.
What Original Medicare Does Not Include That U.S. Seniors Need?
Original Medicare does not cover most types of hearing, vision, or dental care. While Medicare Part A pays for specific dental services that happen in a hospital setting, and Part B covers care caused by an injury, that’s all there is to it. It does not include tooth extractions, dental plates, cleanings, fillings, dentures, and related services. Hearing aids, getting prescription eyeglasses, routine eye exams, and contact lenses are also not part of the plan.
Even Medicare Supplements (Medigap) do not cover these types of medical care. If they do (Enhanced Plans), you will have to pay a higher premium. If these are important to you and you do not want to pay upfront fees per procedure, you can enroll in a Medicare Advantage plan or purchase a supplemental insurance policy that covers specifically these services. Some private insurers offer special policies for vision, dental, and hearing only.
Another thing that Original Medicare does not cover is Long-term Care Coverage. This includes services received in a skilled nursing facility, a day care center for older adults, and an assisted living community. Given that these services can be very expensive, it’s not really a surprise why the government will not cover these costs. For that reason, you might want to enroll in a stand-alone long-term care insurance policy.
Why a Medicare Supplement Plan Is Important
The gaps in the Original Medicare are the reasons why Medigap (Medicare Supplement) is necessary. Because many 65-year-olds need ongoing care – and even if they don’t currently, the consequence of age could eventually reveal new illnesses, Medigap plans offered by private insurers are a necessity.
There are 10 different types of Medigap policies that priced differently depending on the extent of the coverage and benefits that are offered. Medigap may only be acquired if you have Medicare Part A and Part B and can only be purchased through private insurance companies. The coverage of the Medigap plans are standard across the U.S. but the fees will differ by company.
It is, thus, crucial that you shop around and compare rates first before deciding on which Medigap plan to sign up for. Just take note that you only have a limited period before and after your 65th birthday to choose a policy without being required to undergo medical underwriting. During this Open Enrollment Period, insurance providers are required to sign you up regardless of your pre-existing medical condition or health status.
