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

Question

Tony Capraro III · Accepted 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#tony-capraro

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

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 & SC

Answered by Edward Smith, ChFC, CRPS, AIF 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, FL, LA, NM & OH

Answered by Richard Moreno 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

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

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!

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

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.

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

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

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.

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.

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

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.

Answered by John L Herman Jr on March 31, 2025

Broker Licensed in MD, DE & PA

Answered by John L Herman Jr Medicare Insurance Agent

Diana Salisbury · Answer

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

Chad Watkins · 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#chad-watkins

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.

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

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.

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. 737-530-4626 op 2. Gary Henderson gary.henderson@medicaregenius.com

Steve 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 Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer 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.

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

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

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 at bkconnections@comcast.net.

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.

Answered by Daniel Keane on June 2, 2025

Agent Licensed in TX, FL, MI & NC

Answered by Daniel Keane Medicare Insurance Agent

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.

Answered by Babs Atwell on June 16, 2025

Broker Licensed in OH

Answered by Babs Atwell Medicare Insurance Agent

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, NE, UT, WA & WY

Answered by Adam Ashby Medicare Insurance Agent

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.

Answered by Patrick Stinson on April 29, 2025

Broker Licensed in TX, AR, AZ & 9 other states

Answered by Patrick Stinson Medicare Insurance Agent

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.

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!

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.

Answered by Kristen Maurice on May 16, 2025

Agent Licensed in TN, AL, CA & 10 other states

Answered by Kristen Maurice Medicare Insurance Agent

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

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