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

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

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

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

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.

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.

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.

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

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!

Dan "the Medicare Man"
Daniel Maisel Insurance Solutions Medicare Agency 
"Making Medicare Simple"!
(909) 319-5324 
Ca Lic #0620516  -  Npn #2714786 
Www.InsureItDan.com

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

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

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