If you have Original Medicare, you may be wondering what medical expenses are included and why there are gaps in your coverage. Whether you’re new to Original Medicare or have been enrolled for some time, understanding the limitations of your coverage is important as you navigate decisions about your healthcare.
One of the main reasons why Original Medicare doesn't cover 100% of your medical bills is because it operates on a cost-sharing model. Medicare Parts A and B come with deductibles, coinsurance, and copayments that beneficiaries are responsible for paying. To address the gaps in coverage, there are alternatives, including Medicare Part C (Medicare Advantage plans) and Medicare Supplement Plans (Medigap) that you may choose to purchase. In this article, we’ll help you understand why Original Medicare doesn’t cover 100% of your medical bills and the coverage options available to you to address these gaps.
Does Original Medicare cover hospital visits and prescription drugs?
Original Medicare does cover hospital visits, but it’s important to understand the coverage limitations. Original Medicare consists of two parts: Part A and Part B. Part A helps cover hospital stays, skilled nursing facility care, hospice care, and some home health services. However, it does not cover long-term care or custodial care. Part B helps cover outpatient care, preventive services, doctor visits, durable medical equipment, and some home health services.
While Original Medicare covers hospital visits, there are certain costs that beneficiaries are responsible for, such as deductibles, coinsurance, and copayments. For example, Part A has a deductible for each benefit period, and Part B has an annual deductible and requires beneficiaries to pay a percentage of the approved amount for services. Original Medicare doesn’t include prescription drug coverage, so instead, beneficiaries can enroll in a separate Part D prescription drug plan.
What alternatives are there to Original Medicare?
When it comes to healthcare coverage for Medicare plan beneficiaries, Original Medicare is not the only option available. There are two popular alternatives: Medigap and Medicare Advantage plans.
Medigap (Medicare Supplement plans): Medigap, also known as Medicare Supplement Plan, is a private insurance policy that works alongside your existing Medicare Part A and B coverage. It helps cover the out-of-pocket costs that Original Medicare doesn’t pay, such as deductibles, coinsurance, and copayments. With a Medigap policy, you have the freedom to choose any doctor or hospital that accepts Medicare plans.
Medicare Advantage Plan (Medicare Part C): Medicare Advantage Plan (Part C) plans also offer an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and offer the same coverage as Parts A and B, but may include additional routine benefits.
If You’re Shopping for Additional Medicare Plan Coverage, SelectQuote Can Help
Understanding your Medicare plan coverage can seem overwhelming, especially if you’re trying to decide whether you have enough. If you decide to search for a Medicare Advantage plan or Medigap policy, we can help. With nearly 40 years of industry experience, our licensed insurance agents can help you assess your coverage needs and find a plan that’s right for your lifestyle and budget.
