Is Medicare Enough? When to Consider a Supplement Plan

Original Medicare (Parts A & B) offers essential health coverage for hospital and medical services—but is it enough? Many beneficiaries are surprised by the out-of-pocket costs that come with Medicare, like deductibles, coinsurance, and copayments. If you're wondering whether to add more coverage, here's when you should consider a Medicare Supplement (Medigap) plan.

What Does Original Medicare Cover?

Original Medicare includes:

• Part A: Hospital stays, skilled nursing facility care, hospice, and some home health care.

• Part B: Doctor visits, outpatient services, preventive care, and medical equipment.

However, it doesn’t cover everything.

What’s Not Covered?

❌ Prescription drugs (you need a Part D plan)

❌ Routine dental, vision, or hearing care

❌ Long-term custodial care

❌ Most foreign travel medical care

And while it pays for much of your care, you’re still responsible for:

• Part A deductible: $1,632 per benefit period (2024)

• Part B deductible: $240 (2024)

• 20% coinsurance for most services under Part B

  
  

What Is a Medicare Supplement (Medigap) Plan?

Medigap plans are private insurance policies that help pay for the “gaps” in Original Medicare, like deductibles, copayments, and coinsurance. These plans are standardized and named Plans A through N, each offering different levels of coverage.

You must be enrolled in Original Medicare (Part A & B) to qualify, and you’ll pay a monthly premium for your Medigap policy in addition to your Part B premium.

When to Consider a Supplement Plan

Here are key situations when a Medigap plan may be worth it:

✅ You Want Predictable Out-of-Pocket Costs

If you want peace of mind knowing what your healthcare costs will be, Medigap helps reduce surprise bills.

✅ You See Doctors Frequently or Have Ongoing Conditions

The 20% coinsurance under Part B can add up quickly for those with chronic health conditions or frequent appointments.

✅ You Travel Frequently

Some Medigap plans (like Plan G or Plan N) offer foreign travel emergency coverage—Original Medicare does not.

✅ You Prefer Flexibility

Unlike Medicare Advantage plans, Medigap doesn’t require networks. You can see any doctor who accepts Medicare nationwide—no referrals needed.

When You May Not Need a Supplement Plan

A Medigap plan might not be necessary if:

• You’re healthy and rarely visit the doctor.

• You have retiree or employer coverage that supplements Medicare.

• You’ve chosen a Medicare Advantage plan that includes low-cost benefits and extra services.

  
  

How to Enroll in Medigap

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period:

• Starts when you’re 65 or older and enrolled in Part B.

• Lasts for 6 months.

• During this period, you can buy any Medigap plan without medical underwriting.

After this window, you may be denied coverage or charged more based on health status.

Final Thoughts

Original Medicare is a strong foundation, but it doesn’t cover everything. If you want more complete coverage, lower out-of-pocket costs, and greater flexibility, a Medigap plan might be the right choice.

Need help deciding if a supplement plan is right for you? Lindbergh and Associates can help you compare options and find the best coverage.

📞 Call us today or schedule a free consultation to explore your Medicare supplement plan options!