What's the financial risk of sticking with Original Medicare without a Medigap plan?

Question

Tony Capraro III · Accepted Answer

Question: What's the financial risk of sticking with Original Medicare without a Medigap plan? I just saw this question come across, and I didn't even hang up my headset because I had to answer this one. With Original Medicare Part B, the government will pay 80%, and you are responsible for 20% of the total cost. There is no out-of-pocket maximum.

A specific example: I've got a client at CMC who had some heart issues. The bill was $65,000. Thankfully, they have a Medigap policy, which will pay all of their 20% for them. Had they not had the Medicare Medigap supplement policy, they'd be paying $13,000 out of pocket, and I don't know who has that just laying around.

So please, before you make any decisions or non-decisions on Medicare, Original Medicare, Supplement, or Medicare Advantage, speak to someone like myself who deals with it every single day with clients and has real-life experience and real stories to tell about horror stories from making the wrong decisions.

I would be glad to help you. We'll go over the pros and cons of Original Medicare, sticking with that, or doing a Medicare supplement to add to A and B that will pay all of your out-of-pocket costs, or even going to a Medicare Advantage plan, which I believe would be better than sticking with just Original Medicare. Anyway, we're here to help. My office is right on Kelly Street in Manchester, Tony Capraro State Farm. Have a great weekend!

Gary Church · Answer

What is the financial risk of sticking with Original Medicare without a Medigap plan? The risk depends on your financial capacity—your costs are 20% for both Part A and Part B, with no cap, so a life-changing event could result in thousands of dollars in costs. Medigap covers you financially. You would want to have a drug plan.

Answered by Gary Church on October 2, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

There is a GREAT risk if you don't have what they call secondary coverage like a MediGap plan. Medicare covers 100% of the Part A (Hospital) coverage, but with Part B (physician services) it only covers about 80%, the other 20% is what you risk if you don't have a MediGap plan. Also... there is NO LIMIT to the amount of money you are responsible for with that 20%.

Answered by Steve and Sue Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Mike Alexander · Answer

You are subject to 20% coinsurance with no cap on expenses.
You should have a medigap or an advantage plan to reduce your financial risk

Mark Bilgere · Answer

The main risk of not having a Medigap plan is financial. Because Traditional Medicare has a Hospital deductible and copays in addition to the Part B 20% coinsurance with no Stop Loss, you could face catastrophic medical bills. 

By adding a Medigap plan you eliminate having to pay the hospital costs and the 20% Part B coinsurance. In addition to the Medigap premium, you would be responsible for the Part B deductible and once that is met, your Medicare billable charges are paid.

Larry Dalton · Answer

Original Medicare, encompassing Part A and Part B, provides essential coverage but does have some gaps. Beneficiaries are responsible for 20% of Part B costs, an annual deductible, and other potential charges that may arise during a hospital stay, which Medicare may not cover.

These Medgap plans can help individuals better prepare for their healthcare expenses and explore additional coverage options to prevent out-of-pocket expenses with their healthcare services.

Mark Maliwauki · Answer

Original Medicare will cost you 20% of any major medical incident / occurrence. A Medigap plan has a $244 deductible but all expenses would be covered. Of course, there is a $100 + per month premium in addition to your Part B premium of $185 in 2025.

Answered by Mark Maliwauki on August 2, 2025

Broker Licensed in ID, AZ, CA & 13 other states

Answered by Mark Maliwauki Medicare Insurance Agent

Voss Speros · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-the-financial-risk-of-sticking-with-original-medicare-without-a-medigap-plan#voss-speros

Bill Wheeler · Answer

Good question! Original Medicare only pays
 80 % and leaves 20 % to the patient to resolve. 
Another aspect  to Medicare is it does not have a cap on the 20%. If your bill is $100,000.00 you owe 20%of that. This is where a medigap plan or supplement comes in. Another avenue is a Medicare Advantage plan that does set a cap on what you would have to pay.

Edward Smith, ChFC, CRPS, AIF · Answer

There are several things to consider. #1 You could be opening yourself up to multiple deductibles due to the fact that a new Part A deductible could be assessed each benefit period (60) days. #2 there is no maximum out of pocket expense on the 20% you would be responsible for. Original Medicare only covers 80%, you are responsible for the 20% with no cap, each and every year.

Answered by Edward Smith, ChFC, CRPS, AIF on March 31, 2025

Broker Licensed in OH, GA, IN, KY & TN

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Ray McCauley · Answer

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), generally covers inpatient hospital care, doctor's services, outpatient care, some home health and hospice services, and preventive services. It does not cover everything, such as routine vision, hearing, and dental care, long-term care in nursing homes, or custodial care

Original Medicare (Part A and Part B) covers: 
Inpatient Hospital Care:
.
This includes care in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term care hospitals. 
Doctor's Services:
.
This covers most doctor services, including outpatient and some inpatient services, as well as preventive services. 
Outpatient Care:
.
This includes care received outside of a hospital, such as doctor's visits, lab tests, and some medical supplies. 
Home Health Services:
.
Original Medicare covers some home health services, including skilled nursing care and physical therapy, if certain conditions are met. 
Hospice Care:
.
Original Medicare covers hospice care, including pain relief, symptom management, and other services for terminally ill individuals and their families. 
Preventive Services:
.
Original Medicare covers a range of preventive services, such as flu shots, screenings for certain conditions, and annual wellness visits. 
Durable Medical Equipment (DME):
.
This includes items like wheelchairs, walkers, and oxygen equipment. 
Original Medicare generally does NOT cover: 
Routine Vision, Hearing, and Dental Care:
These services are typically not covered, although there are exceptions for certain conditions. 
Long-Term Care:
Original Medicare does not cover long-term care in nursing homes or assisted living facilities. 
Custodial Care:
This includes care that helps with daily living activities like bathing and eating. 
Medically Unnecessary Services:
Services that are not considered medically necessary, such as cosmetic surgery, are g

Christy Jones · Answer

Original Medicare (Part A and Part B) covers 80% of your Medicare covered hospital and doctor bills. A Medicare Supplement plan helps cover the other 20%. When you ONLY have original Medicare (Part A and Part B), your financial risk is having to come up with 20% of all of the Medicare bills you might incur.

Answered by Christy Jones on June 26, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Clarence &quot;Mark&quot; Christiansen · Answer

The financial risk is unlimited if you just have Medicare an and B you’re OK for the first 60 days in the hospital after a deductible and then it gets far worse.

 On the outpatient side of things, you’re on the hook for 20% of all charges with no cap so people who need $1 million worth of outpatient services such as chemotherapy will be looking at a bill in the neighborhood of $200,000.

Steven Graves · Answer

Sticking with Original Medicare without a Medigap plan may seem fine if you're healthy now, but it comes with significant financial risk if your health changes unexpectedly.

Here’s what to keep in mind:

Medicare Part B only covers 80% of outpatient care like doctor visits, surgeries, MRIs, and chemotherapy. That means you’re responsible for the remaining 20%—with no limit on how high those bills can go.

Hospital stays under Part A require you to pay a large deductible and daily charges after 60 days. A longer stay or multiple admissions in a year can quickly add up.

Unlike Medicare Advantage, Original Medicare has no out-of-pocket maximum, so there’s no financial “safety net” to cap your expenses.

If you decide to get a Medigap plan later, you may face medical underwriting, higher premiums, or even be denied coverage, depending on your health and state rules.

In short: Without Medigap, you’re fully exposed to the cost of serious illness or injury. One major event could lead to thousands—or even tens of thousands—in unexpected bills.

Would you like help comparing Medigap options or seeing what coverage would look like for your situation?

Contact us for help.

Vincent Murray · Answer

Huge Financial Risk.  Part A deductible of $1639, Part B deductible of $259.  20% is usually more than the co-pay on a Medicare Advantage plan.  With a Medigap plan, you would pay a higher premium but would have no costs over and above your Part B deductible with a plan G.
Most importantly, you are in a huge Financial risk if you have just original Medicare. NO MAXIMUM OUT OF POCKET with original Medicare.  So God forbid you are 6 months in the hospital and have $400,000 worth of bills... You owe 20% and there is no cap.
With a supplement, you pay only the part B deductible, then you pay nothing.  With a Medicare Advantage plan, you have a maximum out-of-pocket, usually under $9000.

Lauren Fodde · Answer

If you stay on Original Medicare without a Medigap plan, you’re taking on unlimited financial risk — Medicare only covers about 80% of approved medical costs and has no out-of-pocket maximum, meaning one major hospital stay or treatment could cost thousands.

By contrast, a Medicare Advantage plan (Part C) combines your hospital, medical, and often drug coverage into one plan with an annual out-of-pocket limit — typically between $4,000–$8,000. While you’ll have copays and network rules, you’re protected from catastrophic costs.

In short:

Original Medicare + Medigap = highest protection, more freedom, higher premium.

Medicare Advantage = cost limits and extras, but provider restrictions.

Original Medicare alone = highest financial risk.

Jacqueline Proffit · Answer

if you do that, please make sure to obtain a drug prescription plan to avoid a penalty. The primary financial risk of sticking with Original Medicare without a Medigap plan is unlimited out-of-pocket costs due to the absence of an annual spending cap. A single serious illness or extended hospital stay could result in an individual being responsible for tens of thousands of dollars in medical bills.

Answered by Jacqueline Proffit on November 26, 2025

Broker Licensed in FL, AR, CA & 15 other states

Answered by Jacqueline Proffit Medicare Insurance Agent

Nick Mangini · Answer

You are responsible for the remaining 20% coinsurance FOREVER and there is NO MAXIMUM! This means you will ALWAYS PAY the 20% FOREVER! DO NOT just have Original Medicare! You need to get a Supplement Medigap Plan to cover the bills that can easily rack up! 20% of a $100,000 hospital bill is a lot of money.

Answered by Nick Mangini on August 24, 2025

Broker Licensed in FL, AL, AZ & 32 other states

Answered by Nick Mangini Medicare Insurance Agent

Richard Moreno · Answer

Without a Medicare supplement you will be responsible for what original Medicare doesn’t cover. Ther is no maximum out of pocket. You pay a high deductible for hospital stays and 20% co-insurance. Extended care in a skilled nursing facility could lead to substantial out of pocket costs. Your premium for a supplemental will cover the 20% of what Original Medicare doesn’t pay and you will have less out of pocket expenses l.

Answered by Richard Moreno on June 12, 2025

Broker Licensed in TX, CA, FL, LA, NM & OH

Answered by Richard Moreno Medicare Insurance Agent

Luke Rhoads · Answer

The part A deductible $1632 for inpatient hospilization, the co-pays for any stay longer than 60 days. Then the most likely and biggest risk is the part B 80%-20%. Meaning you pay 20% of your outpatient services provided with no cap on your exposure.

Answered by Luke Rhoads on June 24, 2025

Broker Licensed in OK

Answered by Luke Rhoads Medicare Insurance Agent

Darlene Murphy · Answer

Potentially, 20% of approved services not covered by Original Medicare. Plus, Part A & B deductibles, and the rate per day for care not covered.

Robert Lukasik · Answer

The down fall or financial risk to staying with original medicare is you will pay 20% of the services you need or use. You could also have several deductibles for hospital or skilled nursing for multiple stays in a year. Another risk is it does not cover dental, vision or hearing should you need those services and you will need to get a stand alone prescription plan to avoid penalties as it does not cover prescriptions either.

Answered by Robert Lukasik on November 27, 2025

Broker Licensed in NY, FL & PA

Answered by Robert Lukasik Medicare Insurance Agent

Dutch VanHoesen · Answer

I have a client who if she had went with her first choice of a Medigap plan her annual cost would be around $2,400. She decided to take a less expensive route and enrolled in a Medicare Advantage plan. She was diagnosed with a health issue requiring a doctor to administer shots in her eye every quarter for the remainder of her life. This cost is reaching her out of pocket maximum of $5,500 which is more than twice the annual cost of her supplement. In this particular case it would have been more cost effective for her to have been on the Medigap plan costing her $2,400 per year.

Answered by Dutch VanHoesen on March 26, 2025

Broker Licensed in FL

Answered by Dutch VanHoesen Medicare Insurance Agent

David Bell · Answer

Original Medicare does not have an out of pocket maximum for co-insurance. What this means is you will pay 20% of the bills with no end. This could be devastating to your finances. It is my #1 reason to have either a medigap (supplement) or Medicare advantage. Both limit that obligation.

Answered by David Bell on May 26, 2025

Agent Licensed in ID, AZ, CA & 8 other states

Answered by David Bell Medicare Insurance Agent

Daniel Maisel · Answer

Medicare Parts A (Hospital) and PartcB (Doctors) are a wonderful provision that helps care for those turning 65.

The danger financially of you do not have a Medicare Supplement or Medi-Gap, each person is subject to the following:
Hospital stay deductibles  multiple tinnes each year for different health issues. 
Doctor deductible. 
A & B is a 80/20 plan.  
Thus without a Medi-Gap plan you would have no small co-pay per visit and would be responsible for 20% of treatment costs.
Their are many other CO-payments.

Their is no coverage for:
Prescription 
Dental
Vision
Hearing
Unless part of another health condition. 

Call myself or anyone of many Certified Healthcare Professionals, educated, certified and trained to aid you select the plan that fits your needs and budget.

My assistance is complimentary. 
You pay me nothing. 
All licensed agents & brokers are paid by any insurance plan you select, to pay for our services. 

I hope this helped!

Adam Ashby · Answer

The biggest risk is Out of Pocket Maximum. Original Medicare does not have a ceiling. Should you be faced with an unfortunate diagnosis - the sky is the limit as far as your responsibility. Even if you simply want the protection of an Out of Pocket Maximum a Medicare Advantage is a way to protect yourself financially.

Answered by Adam Ashby on May 19, 2025

Broker Licensed in CO, GA, IL & 6 other states

Answered by Adam Ashby Medicare Insurance Agent

Lilyana Uzdenova-Gomez · Answer

The biggest risk may just be the fact that there is no limit to how high the actual out of pocket expenses could go if someone is experiencing significant health issues. Even though there are precise deductibles, copays, and coinsurance, those apply to each of the occurrences, no matter how much money someone has already paid in that year, or years before. Medigap can significantly reduce that potential expense, or even limit it to a relatively small yearly deductible, depending on the plan chosen.

Answered by Lilyana Uzdenova-Gomez on January 19, 2026

Broker Licensed in FL

Answered by Lilyana Uzdenova-Gomez Medicare Insurance Agent

Mark Zaruba · Answer

The way I see it, you will pay much more if you just stick with original Medicare. Original Medicare, from the beginning, was not meant to be your entire health care option. It was set in place originally to HELP seniors to manage their healthcare costs. The fact that original Medicare does not have an MOOP (Maximum Out of Pocket) annual limit is a financial risk nobody should take especially since you can enroll in a zero-dollar Medicare plan premium which must, by federal law, be as good as original Medicare. With this you can also have a drug plan in place to keep you from the Part D late enrollment penalty.

Answered by Mark Zaruba on March 2, 2026

Agent Licensed in WI & IA

Answered by Mark Zaruba Medicare Insurance Agent

Michael Wehner · Answer

Original Medicare which consists of Part A and B only covers 80% of part B (outpatient services) with no out of pocket limit. It also has a limit on the number of lifetime days you will be covered in the hospital. Additionally, original Medicare does not address prescription drug costs unless you purchase separate drug coverage (Part D). You can choose to purchase a Medicare Advantage plan (Part C) that includes prescription drug coverage or purchase a Medicare Supplement plan along with a separate stand alone drug plan to help cover what Original Medicare does not.

Answered by Michael Wehner on July 14, 2025

Agent Licensed in IN, KY, NC, OH, PA & SC

Answered by Michael Wehner Medicare Insurance Agent

Rodney Powell · Answer

MEDICAL BANKRUPTCY. You might be exposing your savings to unlimited risk. There’s no stop-loss on out-of-pocket costs.

If you can't afford the premiums for a standard Plan G (or Plan N), consider an Advantage plan, which at least has a maximum-out-of-pocket limit to protect your finances.

If cost is an issue, as it can be in some states, I would opt for a high-deductible Plan G alongside a cash emergency fund.

This allows you to keep the portability and flexibility of Original Medicare without being subject to carrier prior authorizations.

Cody Hebden, MBA, CLU, FLMI · Answer

Unlike the health insurance plans you were most familiar with during your working years, Original Medicare does not have an annual maximum out of pocket. This means that you could be at risk of losing substantial savings to pay for medical bills. This is where private insurance comes in, to help cap and limit your financial exposure and risk.

Answered by Cody Hebden, MBA, CLU, FLMI on August 13, 2025

Broker Licensed in NC & SC

Answered by Cody Hebden, MBA, CLU, FLMI Medicare Insurance Agent

Jennifer Sigman · Answer

Original Medicare is a strong foundation, but it doesn’t limit your out-of-pocket costs. A supplement helps protect you from the unexpected so one health event doesn become a financial burden. Without a Medigap plan, Original Medicare only covers about 80% of your medical costs, with no cap on what you could pay out-of-pocket. That means one serious health event could leave you responsible for thousands.

Answered by Jennifer Sigman on February 23, 2026

Broker Licensed in OH, AL, IA & 12 other states

Answered by Jennifer Sigman Medicare Insurance Agent

Justin Lucas · Answer

As I tell everyone that stays with just Original Medicare, I do not advise it due to the fact that there is NO STOP LOSS. And you still have to have a Part D plan.

Gregory Firmbach · Answer

Good question… in my practice I have had numerous clients in this situation. Most were very healthy and faired very well… for a time! The Risks are numerous…
1. Going Medicare Bare exposes you to pay for all of the 20% (plus excess charges) that medicare doesn’t pay for part B medical expenses. You are also liable for the Part A deductible occasionally for hospital admissions. The deductible is about $1,700 dollars and has been increasing year over year. Medicare Part A provides you with the first 60 days of hospital coverage Lifetime (after the deductible). In 2025, the 61st to 90th day copay is $419 per day. The 91st and beyond copay is $838 and applies to the 60 reserve days. This can get very expensive with no upper limit or Maximum Out of Pocket (MOOP). 
Other options exist:
2. A MediGap Plan. MediGap Plans pay some or all of the medical expenses Medicare doesn’t cover. You can apply for a Medicare Supplement at any time. The cost of Medigap plans range from $200 to $300 per month depending upon your age. If you have missed your open enrollment period the company requires medical underwriting in order to approve our application. And you could be denied. At some age you could develop or acquire a disability and or disease which could prevent you from being able to pass the underwriting to acquire a Medicare Supplement or MediGap Plan. 
3. Medicare Advantage (Part C): You have the option to enroll in a Medicare Advantage plan during any open or special election period which is designated by CMS (Medicare). Part C plans do not require answering health questions and accept all eligible members. You are eligible if you live in the plans service area and have both Medicare Parts A & B. These plans pay medical expenses after a copay or co-insurance and will have a MOOP

Patrick Metcalf · Answer

Sticking with Original Medicare (Parts A and B) without a Medigap (Medicare Supplement) plan can expose you to significant out-of-pocket costs because Medicare doesn’t have an annual limit on what you might pay for covered services. You’re responsible for 20% of all Part B expenses — including doctor visits, outpatient care, surgeries, and medical equipment — after meeting your deductible. If you face a serious illness or require frequent treatments such as chemotherapy, dialysis, or hospital stays, those 20% coinsurance payments can add up quickly and create major financial strain.

In addition, Original Medicare doesn’t cover many common healthcare needs such as prescription drugs, routine dental or vision care, or extended stays in skilled nursing facilities beyond the limited covered period. Without a Medigap plan to help fill those coverage gaps, beneficiaries are essentially “self-insuring” against potentially high medical bills, making them financially vulnerable in the event of unexpected or chronic health issues.

Hank Ellis · Answer

If you have a medical event where you would be hospitalized you would have a part A deductible to meet of 1676.00 dollars. If you were hospitalized over 60 days you have a coinsurance responsibilty of 419 dollars a day for day 61-90 and 838 dollars day 91-150. You would also have to meet your part b deductible of 257.00 for doctor visits.

Answered by Hank Ellis on August 25, 2025

Broker Licensed in WV

Answered by Hank Ellis Medicare Insurance Agent

Sabri Amara · Answer

The risk of sticking to only Original Medicare is financial exposure. Original Medicare has no stop loss or out of pocket maximum. With only Original medicare you are responsible for hospitalization deductibles every time you are hospitalized which are not yearly deductibles this is called a benefit period deducible. Also equally as painful you are responsible for 20% of all medical costs with no limit on how much those costs can add up to.

Answered by Sabri Amara on January 26, 2026

Broker Licensed in IN, AZ, FL & 13 other states

Answered by Sabri Amara Medicare Insurance Agent

Shauneen Sullivan · Answer

The financial risks associated with having only Original Medicare without a Medigap policy can be quite substantial. Original Medicare Parts A & B will cover up to 80% of your medical bills, assuming you see participating providers of Medicare. The remaining 20% of the medical bills that Medicare doesn't cover, would be your responsibility to pay. It is also an unlimited amount, meaning there is no cap or stop loss on this amount. In the event of a catastrophic illness or medical issue the costs can be quite high. A Medigap policy would pick up the remaining 20% of costs that Medicare doesn't cover. Your out of pocket costs would only be the monthly premium for your Plan and a small annual deductible ($257 in 2025) depending on your type of Medigap Plan.

Answered by Shauneen Sullivan on October 20, 2025

Agent Licensed in FL, AZ, GA & 9 other states

Answered by Shauneen Sullivan Medicare Insurance Agent

Ron Ray · Answer

Original Medicare has no out-of-pocket maximum. That means there’s no limit to what you could pay if you get seriously sick. You’re responsible for hospital deductibles and 20% of most medical bills, with no cap. A major illness can easily mean tens of thousands of dollars.

If you skip Medigap when first eligible, you may not be able to get it later if your health changes.

Simply put: Original Medicare alone leaves you financially exposed. Medigap turns unlimited risk into predictable costs.

Steven Bleicher · Answer

Medicare Parts A and B pay 80% of the value of any sanctioned procedure. By not picking up a Med. Supplement, the remaining 20% is coming out of your own pocket. If it is a big expense, why would you NOT wish to have it paid for??

Answered by Steven Bleicher on May 29, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

That is 20% coinsurance you would owe if claims are Medicare approved with no limit. Go with a Medicare Advantage plan.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare to get information on all of your options.

Diana Garner · Answer

Sticking with Original Medicare poses a significant financial risk. Without a Medigap plan, you're responsible for the full amount of the Part A deductible and 20% coinsurance for Part B expenses.

Medigap plans typically cover these costs as well as potentially extended hospital stays beyond Medicare's 60-day limit. 

Original Medicare has no out-of-pocket maximum, meaning your costs can continue to accumulate over time without a Medigap.

Timothy Brown · Answer

Without a Medigap plan, you will be subject to 20% coinsurance of charges that Medicare doesn’t cover. It may seem insignificant for a doctors office visit but it can be very costly if a catastrophic event occurs or hospitalization or a surgery is necessary.

Answered by Timothy Brown on May 25, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Michael Pyers · Answer

There is no maximum out of pocket for straight Medicare.  You would have to pay for a Medigap Plan, but it seems like pay me now or pay me later.

Frank Carta · Answer

Texting wears me out, but you have another option and I am better at oral communications.
I am not allowed to ask you to call me but you have that option to initiate yourself if you wish to do so.

Rick Boyd · Answer

Original Medicare only pays 80% of the hospital and doctor visit costs, the remaining 20% is the responsibility of the consumer. There is no yearly cap on Medicare expenses, a Supplement plan (G or N ) would cover these expenses. Regardless if you have Original Medicare only or Original Medicare with a Supplement, you must also purchase a part D medication plan.

Answered by Rick Boyd on March 16, 2026

Broker Licensed in KY, AZ, CA & OH, TN, TX & UT

Answered by Rick Boyd Medicare Insurance Agent

Yasmery Vargas · Answer

Original medicare does not have a maximum out of pocket. Your bills will continue to come in as its used. Its not 100% medical protection. medicare supplement(medi gap) picks up what original medicare does not in terms of medical bills.

Answered by Yasmery Vargas on May 4, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Chad Watkins · Answer

What does Medicare cover and not cover? To answer this question, we need to take a look at the two different parts of Medicare. Medicare has Part A, which is your hospital coverage, and Part B, which is your medical coverage. Part A, typically, people do not pay a premium for unless you did not work for at least 40 quarters within your lifetime. Part A is going to cover your inpatient hospital care, some skilled nursing care, and hospice care. There is a deductible of $1,676 every time you go in the hospital, and if you're there more than 60 days, there is a copay of $419 per day from day 91 to 150. It goes up to $838 per day, and then after that, you will be paying for everything as it is not covered.

For skilled nursing facility care, Medicare will cover you for the first 20 days, and then after that, it's $209.50 per day up to day 100. After day 100, you're not covered, so everything will be out of pocket. Your Part B covers your doctor services, your outpatient services, including surgery, and some other services and supplies that are not covered by Part A. There is a premium for your Part B; most people will pay $185 per month, but it does go up based on your income. Part B has an annual deductible of $257, and then after that, 20% is what your coinsurance would be. So, there are two different types of plans that you can get: Medicare Supplement and Medicare Advantage to cover the things that Medicare does not cover.

Terry Salak · Answer

With OM (Original Medicare) you are responsible for all the deductibles connected to OM as well as the 20% that OM does not cover.  With a Medicare Supplement (Medigap) plan, that plan would cover all these costs as long you continue to pay your Medicare Part B premium and your monthly Medicare Supplement premium.

Based on your Medicare Part B effective date, you may have an additional Medicare Part B annual deductible, which I would be happy to explain in more detail at any time.

Mary Salmon · Answer

Original Medicare has deductibles and co-insurance that is required to be paid by the beneficiary. Medicare pays 80% of approved charges after the deductibles, leaving the beneficiary with the remaining 20% to be paid out of pocket. The benefit to having a medigap plan (Medicare Supplement) is to pay the Part A deductibles and coinsurance as well as the Part B coinsurance on your behalf.

Answered by Mary Salmon on April 22, 2025

Broker Licensed in TX & OK

Answered by Mary Salmon Medicare Insurance Agent

Diana Salisbury · Answer

Medicare will pay for 80% of medically-needed services.  You will be personally responsible for the remaining 20%.

Betty McCarty · Answer

Navigating Medicare choices is an important decision, and opting for Original Medicare without a Medigap plan can expose you to significant out-of-pocket costs. Without Medigap, you are responsible for covering the Part A deductible, as well as 20% coinsurance for Part B medical expenses.

Medicare Part A Costs for 2025

•	Deductible: $1,676 per benefit period (the amount you pay before Medicare begins covering hospital costs).
•	Hospital Stay Costs:
o	Days 1–60: Medicare covers your stay at no cost.
o	Days 61–90: You’ll pay $419 per day.
o	Beyond 90 days (Lifetime Reserve Days): You’ll pay $838 per day, up to 60 reserve days over your lifetime.

Medicare Part B Costs for 2025

•	Coverage: Outpatient care, including doctor’s visits, preventive services, scans, and tests.
•	Standard Monthly Premium: $185.00.
•	Annual Deductible: $257, meaning you must pay this amount before Medicare Part B begins covering services.
•	Coinsurance: After meeting the deductible, you’ll be responsible for 20% of covered medical expenses.

Planning ahead can make a huge difference in your financial security and peace of mind. If you have any questions or need further guidance, please don’t hesitate to reach out—we’re here to help! Feel free to email us.

Satoshi Aoki · Answer

If you enroll in Medicare without a Medigap plan, you must pay a lot for medical care, especially Part A hospitalization. 

For example, if you are hospitalized for 120 days, you will have to pay 
Deductible: $1,676, 
(61 days to 90 days): $419/day = $12,570
(91 days and after): $838/day = $25,140
TOTAL: $1,676+$12,570+$25,140= $39,386

, respectively, if you only have Medicare. 
However, if you have a Medigap plan, you will be covered. A lot of Medigap plans will cover Part B depending on the type of Medicap plan. 
For more information, it is a good idea to ask the agent from AGENTS HUB.

Lou Spatafore · Answer

If you have original Medicare without a Medigap plan you are at great financial risk. You will be responsible for the Part A deductible of $1736 if you are hospitalized and Medicare will only pay about 80% of your medical costs and you will be required to pay the 20% balance with no maximum cap. For instance, if you had a surgery and hospital stay that costs $500,000, Medicare will only pay about $400,000 and you are responsible for the rest, or $100,000. This could have an adverse effect on your retirement plan. If you have a Medigap Plan G or N your plan cover your portion including the Part A deductible. A Medigap plan mitigates your financial risk for medical coverage costs.

Answered by Lou Spatafore on March 9, 2026

Broker Licensed in WV, FL, GA & 10 other states

Answered by Lou Spatafore Medicare Insurance Agent

Carolyn Duncan · Answer

Out of pocket cost could truly impact a retirement lifestyle and reviewing options that can both curb the out-of-pocket cost and possibly the high cost of some coverage premiums is an agent's responsivity to find solutions you may not know exists.

Answered by Carolyn Duncan on July 16, 2025

Broker Licensed in FL, CA, CO & 12 other states

Answered by Carolyn Duncan Medicare Insurance Agent

Robert Helmkamp II · Answer

Only having Original Medicare may seem like a logical decision, you are able to be treated by any hospital or doctor who accepts Medicare, so there is no network you need to take into account when finding medical care. The problem is the cost associated with Original Medicare. Without a Medigap Plan, sometimes called a Medicare Supplement plan, you will have deductibles and coinsurance on both Part A and Part B services. Here is the breakdown:

Part A
-Deductible=For each benefit period (starting with a hospital stay), the deductible is $1,676.

(* A benefit period ends when you have not received inpatient hospital care in 60 consecutive days, after this period ends you will need to pay the deductible again if your are admitted to the hospital*)

-Co-Insurance= $0 for days 0-60   $419 per day for days 61-90  $838 per day for days 91 and beyond.

Part B
-Deductible=The annual deductible is $240. 

-Coinsurance=Generally, you pay 20% of the Medicare-approved amount for most services after you meet the deductible

Victoria Shiu · Answer

Sticking with Original Medicare alone exposes you to unlimited financial risk. For someone with significant health issues, this could be financially devastating. A Medigap plan or Medicare Advantage plan adds protection by capping or covering those out-of-pocket costs. Do NOT get into medical debt when I can make sure you are covered!

Answered by Victoria Shiu on August 21, 2025

Broker Licensed in SC, AL, AR & 32 other states

Answered by Victoria Shiu Medicare Insurance Agent

Javier Salguero · Answer

Sticking with Original Medicare without a Medigap (Medicare Supplement) plan exposes you to significant, potentially unlimited financial risk, primarily because there is no annual out-of-pocket maximum. Without a supplemental plan, you are responsible for 20% of all Part B (outpatient) services, with no cap on your total exposure.

Answered by Javier Salguero on March 30, 2026

Broker Licensed in CA & NV

Answered by Javier Salguero Medicare Insurance Agent

Fred Manas · Answer

The financial risk of sticking with Original Medicare without a Medigap plan is that there's no out-of-pocket maximum, meaning your healthcare costs could be substantial if you experience a serious illness or injury. Without Medigap, you're responsible for 20% of Medicare Part B costs, plus deductibles for both Part A and Part B, and potentially costs for services not covered by Medicare. 
Here's a more detailed breakdown:
No out-of-pocket maximum:
.
Original Medicare (Part A and Part B) doesn't cap your yearly expenses. This means you could face large bills for coinsurance (the 20% of Part B costs), deductibles, and potentially uncovered services. 
20% coinsurance for Part B:
.
After you meet your Part B deductible, you're responsible for 20% of the Medicare-approved amount for doctor's visits, outpatient procedures, and other services. 
Part A deductible:
.
For each hospital stay, you have a deductible (currently $1,632 in 2024) that you must pay before Medicare starts to pay. 
Limited coverage for skilled nursing:
.
Original Medicare has limited coverage for skilled nursing facility stays, and it doesn't cover long-term care services like assisted living or custodial care. 
Vision, hearing, and dental not covered:
.
Original Medicare does not cover routine vision, hearing, or dental services.

Gary Henderson · Answer

Medicare covers 80%, no cap on the other 20%. So hospital bills could be a huge financial risk, along with the hospital deductibles are high. 1676.00 for first admittance per year.  plus, additional if you are readmitted throughout the year. 
Get a Medicare supplement plan. Call me to go over your options... Gary Henderson.

Andrew Kramer · Answer

Wow, the financial risk is enormous! Do the math. What do you think the Medicare allowable charge would be for a hospital stay, including possible surgery? The cost likely starts at $50K and rises to maybe $100K or more. Now do the math, what's 20% of that $$? That's your risk.

Answered by Andrew Kramer on August 18, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Carol Thompson · Answer

The cost shared is 80 % (Medicare pays) 20% (you pay). So will be responsible to pay 20% of most medical expenses.

Suzanne Lamperti · Answer

Origional Medicare without a Medigap plan leaves the individual solely responsible for the 20% Medicare does not cover.

Todd Bostic · Answer

It could be very hard because you’ll have to pay 20% of the cost of the medical expenses because Medicare only pays 80% and with a Medigad plan, that would cover the extra expenses.

Jack Mayer · Answer

Hospital deductible each hospital stay separated by 2 months, daily hospital co payments after the 20th day and 20% of all your outpatient medical and any excess charges beyond what Medicare approves and allows

Answered by Jack Mayer on March 16, 2026

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Deborah Webster · Answer

Medicare is a straight 80/20 plan with deductibles on A & B. Medigap plans lower that potential out-of-pocket and eliminate the A deductible. If you're eligible for a plan F medigap, you also eliminate the part B deductible.

Answered by Deborah Webster on May 15, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Jennifer Kalbach · Answer

Original Medicare refers to Part A & B only. A Medi Gap Plan G covers 100% of Part A coinsurance and hospital costs up to 365 days, part B coinsurance or copays, First 3 pints of blood, Part A hospice care coinsurance or co pay, skilled nursey facility care coinsurance and Part a Deductible, Medicare Part B excess charges, and co pays for doctors and ER room.

Answered by Jennifer Kalbach on December 1, 2025

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Carol Conner · Answer

You will be responsible for a lot of things that Medicare doesn’t cover and it can be very expensive if you have to to use those services so having a Medicare gap policy or Medicare advantage would be best decision to make when Medicare kicks in at age 65

Answered by Carol Conner on November 23, 2025

Broker Licensed in TX

Answered by Carol Conner Medicare Insurance Agent

Karen Ansell · Answer

The financial risk can be great. With no maximum out of pocket.

Part A hospital
Days 1-60   $1676.00 deductible, payable every benefit period.
Days 61-90  $419.00 per day charge
Days 91-150  $838 per day
After day 150 you pay 100%

Skilled Nursing care  1-20th day $0 copay
                                      21 - 100 days $279 per day

Part B "doctors services in or out of hospital, testing, medical equipment, etc."
You pay $257 deductible, 20% of approved and excess charges if non-assignment charge

Eizel Mere · Answer

The financial risk is being responsible for 20% of the cost. There is no maximum out of pocket. 
The only people who should consider that are people with Medicaid and VA/Tricare and even those are loosing out on benefits like food cards, dental, vision, hearing, etc.

Rodolfo Rojas · Answer

You will have to get a D coverage, which is a prescription.
You will be responsible for your part B, which is $185 premium this year, which the government take from your check. Furthermore, you will have a deductible of $1,676 for your part A, hospital. 
You will be responsible for 20% of the cost of all procedures that are not included. 

If you can afford all that, go for it. Medicare Advantage is what I would suggest.

Don Hansford · Answer

The financial risk is substantial. Along with the deductibles and coinsurance that would need to be paid out of pocket, Original Medicare has no cap on how much out of pocket you could be liable for. Both a Medigap plan and a Medicare Advantage plan protect you from having a catastrophic financial situation, limiting your annual out of pocket costs.

John Messler · Answer

If you stay on original Medicare without picking a Medigap plan, you’re responsible for the 20% that Medicare a Medicare B don’t pay. This can be a substantial cost. You’ll also want to ensure you have a part D plan or your subject to penalties once you decide to get a party plan.

John L Herman Jr · Answer

Original Medicare covers 80% of the costs of Hospitals and Doctors... the value of a MEDIGAP PLAN is that your exposure for the other 20% is covered.  Why not consult with an Independent Broker who charges NO FEE for showing you all of the options available to protect you from the 20% exposure you have.

Chad Hardy · Answer

If you stay with Original Medicare and don’t add a Medigap (supplement) plan, your biggest risk is that there’s no cap on what you might pay out of pocket. Medicare covers a lot, but it only pays about 80% of approved medical costs after deductibles. That means you’re on the hook for the other 20%—and if you have something big happen, like surgery, hospital stays, or ongoing treatments, that 20% can add up really fast.

With Medigap, you’re basically buying protection against those unpredictable bills. Without it, you could be fine if you only see the doctor once in a while, but you’re exposed if something serious comes up since there’s no maximum limit on what you could owe.

Shahwali Hotaki · Answer

Without a Medigap plan, Original Medicare has no out-of-pocket limit, meaning you could face high medical bills if you need frequent or expensive care—especially for hospital stays, surgeries, or long-term treatment. You’re responsible for 20% of most costs with no cap.

Christine Brewer · Answer

Sticking with Original Medicare without a Medigap (Medicare Supplement) plan exposes you to significant, potentially unlimited financial risk, primarily because there is no annual out-of-pocket maximum. Without a supplemental plan, you are responsible for 20% of all Part B (outpatient) services, with no cap on your total exposure.

Answered by Javier Salguero on March 30, 2026

Broker Licensed in CA & NV

Patrick Stinson · Answer

Staying with Original Medicare without a Medigap plan can lead to significant financial risk, as it means you're responsible for paying a portion of your healthcare costs, including deductibles, copays, and coinsurance. Without a Medigap plan, these costs can add up quickly, especially if you need a major hospital stay or have ongoing health issues.

Fran Lovelace · Answer

There is no cap on the 20% that you pay with original medicare.  You need either a medigap or a medicare advantage to cap your out of pocket costs.  Also, there is no Rx coverage in original medicare.  If you do a medigap plan you can get a stand alone Rx plan or if you do a medicare advantage plan, you can get one that includes Rx coverage.

Mark Walker · Answer

20% of all expenses Medicare doesn’t pay to an unlimited figure. That seems like a tremendous risk in my book. 

Good luck with that.

Robin Duffey · Answer

Without a Medigap plan you would be responsible for 20% of all medical/hospital charges, which can be hugh considering a major operation could run up to 50,000 = 20% would be 10,000 and that is without a 15% additional charge which some hospital can charge over billing Medicare.

Jermaine Williams · Answer

You will be subject to high deductible and high coinsurance without the security of having a Medicare Supplement plan or a Medicare Advantage plan. Original Medicare only covers a portion of your medical costs.

Kim Mitchell-Hargis · Answer

The financial risk is huge if you only have Original Medicare.  Original Medicare is $185 a month for the year 2025 (based on earnings).  There is no Prescription Drug coverage and no max out of pocket.  You could go broke with hospital and doctor visits if something very serious medically happened to you.  
The Medigap plan would cost you anywhere from $150** a month to $250 (for 65 years old)*** plus the drug plan which could be as low as $35 **a month and then add the $185 a month for the part B that you must pay.  But, the Medigap plan will benefit you and keep you from going bankrupt.

**This is just an estimate.  Plans vary based on age/location/and what type of plan you choose.  Also important is make sure you can afford the monthly payment based on your budget.  My members pay on average $450-$500 a month total for their Medigap plan.
***If you are under 65 years old and eligible for Medicare the prices for a Medigap plan are substantially higher.

Dennis Sullivan · Answer

The financial risk of staying on basic medicare is the responsibility of an 80/20 split. Meaning the beneficiary could owe 20% of the bill after a procedure. $100 Dr. Bill could cost 20$. That 20$ is definitely picked up by a medigap plan or an advantage plan. Staying on basic medicare is not the way forward!!!

Marta Iris González · Answer

Si te quedas solo con Medicare Original (Partes A y B) sin un plan Medigap, corres un alto riesgo financiero porque:
	•No hay límite anual de gastos de tu bolsillo.
	• Pagas deducibles y 20% de copago por la mayoría de servicios médicos.
	• Hospitalizaciones o tratamientos costosos pueden generar miles de dólares en facturas.
	• Medicare no cubre dental, visión ni audífonos.

 Un plan Medigap ayuda a cubrir esos costos y te protege de gastos médicos inesperados.

Brenda Skasko · Answer

You are responsible for the deductibles and cost sharing of Parts A & B, which have no limits.  And depending on when you would choose to possibly get a Medigap plan, there may be penalties involved, depending on your situation. Always consult a licensed professional agent/broker for assistance.

Daniel Keane · Answer

The risk is being subjected to deductibles on Part A and B and 20% coinsurance on medical bills. The coinsurance on a $100,000 medical bill could be as high as $20,000. A Medigap plan is not required as one could also go with Medicare Advantage Plan.

Babs Atwell · Answer

Original Medicare is subject to Part A and Part B deductibles as well as no maximum out of pocket protection. Not to mention no prescription drug coverage. If you don’t have a good agent or broker helping you navigate through your Medicare choices, you could experience significant negative financial impact long term.

Brian Williams · Answer

Original Medicare has a deductible for Part B and Part D (prescription drugs). Once the deductible is met, you pay and coinsurance of 20% for most doctor services and outpatient care.  A Medigap policy will cover the coinsurance expenses. A Medigap policy requires a monthly premium and require an underwriting process to determine eligibility and the monthly premium rate.

David Schult · Answer

Good question.  Having a Supplement or Advantage plan is beneficial in many ways. Let's look at what happens if you stick with Medicare A&B (you will need to get a Part D plan).

If you stick with Original Medicare alone (no Medigap):

No spending limit – you keep paying your share no matter how high the bills go.

Hospital stays get expensive – after a couple months, you could owe hundreds per day, then everything after that.

Big treatments will equal big bills – you pay 20% of things like surgery, cancer care, or dialysis, which can be tens of thousands.

No help overseas – Medicare doesn’t pay if you get sick outside the U.S.. Without a Supplement (also known as Medigap)or an Advantage plan, one major illness could drain your savings because there’s no cap on how much you might owe.

Annette Newman · Answer

Sticking with Original Medicare without a Medigap plan (Medicare Supplement) is essentially a gamble on your health because Original Medicare has no annual out-of-pocket maximum.

Unlike almost every other modern health insurance plan, there is no "ceiling" on what you might have to pay in a year. If you face a catastrophic illness or a chronic condition requiring expensive outpatient treatments, your 20% share of the costs could continue indefinitely.

David Cranford · Answer

You face a 20% co-insurance for all medical services with no limit or maximum. It is not the best course financially to make.

Dorthea Hughes · Answer

The financial risk would be having to pay for dental vision hearing prescription cost co-pays and deductibles out-of-pocket

Bobbi Lincoln · Answer

Sticking with original Medicare without a Medigap plan carries an uncap financial risk that can easily reach tens of thousands of dollars

Debra Hartman · Answer

Not all medical, drug fees may be covered, you may have out of pocket expenses. 
Can be a risk if you have limited income

Donna Hernandez · Answer

You would be responsible for 20% with no annual cap, your Part A deductible, if you’re hospitalized multiple times you may have to pay it more than once, there is no max out of pocket with original Medicare.

Justin Hundley · Answer

Sticking with Original Medicare without a Medigap plan carries significant financial risk due to potential out-of-pocket expenses. Original Medicare has deductibles, copays, and coinsurance, and it lacks an out-of-pocket maximum, meaning expenses can continue to rise without a limit. 

A Medicare supplement plan can help cover most of the portion of Medicare that typically isn't covered, providing peace of mind and predictability. Working with a local agent is the most efficient way to determine what plans are available in your area, and what options would best fit your healthcare needs!

Jose Silva · Answer

With original medicare there is no hospital out of pocket max which can cost you thousands if you go to the  hospital at least twice in a year. Medigap will cover those expenses that medicare wont. Example 20% coinsurance, hospital $1725 deductible every time you go to hospital if its 90 days apart etc...

Elizabeth Holly · Answer

If you choose to only use original Medicare, than you will have to pay prescription drug’s out of pocket- and you will receive a penalty for every month you are not enrolled in a part D plan. 
You will also be subject to the Medicare part B deductible, 20% of every covered part B service, and more. It’s really important to make the right choice from the beginning and then speak with your agent at least annually after that.

Jeff Linabary · Answer

You will subject yourself to a 20% exposure in all medical costs whether it with the hospital's or Doctors.

Morgan Greer · Answer

The major risk is the UNCAPPED 20% coinsurance for Part B costs. Medicare picks up 80%, and you take on the 20%. So let’s take a cancer diagnosis with 6 months of chemo. There could easily be $1M or more in Part B costs, which means you are paying $200,000! This is how medical debt happens.

Good news, there are ways to make sure you NEVER have to be exposed to the 20%, and please reach out so we can educate and then get you the right products so thus never happens to you.

Janet Sterling-Cameron · Answer

It leaves you exposed to significant and unlimited out of pocket costs.  
If you’re hospitalized you have to pay the Hospital copays and deductible (per benefit period- can be multiple times per year).  There is just no dollar limit in the 20%, you pay indefinitely.

Kristen Maurice · Answer

It is financially risky to have Original Medicare with no Medigap plan as Original Medicare has no maximum out of pocket. This means there is no cap to your medical expenses. This could potentially lead to hundreds of thousands in bills. It is always recommended to have either a Medigap or a Medicare Advantage plan to pair with Original Medicare to ensure you have a cap to your out of pocket medical costs.