Original Medicare with Medigap and a Standalone Prescription Drug Plan: Pros and Cons

When navigating Medicare options, one popular approach is to combine Original Medicare (Parts A and B) with a Medigap (or MedSup) policy and a standalone Prescription Drug Plan (Part D). This setup offers a comprehensive approach that covers hospital, medical, and prescription needs, plus added protections from high out-of-pocket costs. However, it’s important to consider both the benefits and limitations of this approach and how to handle “extra” needs like dental, vision, hearing, and fitness.

Here’s a look at the pros and cons of combining Original Medicare with Medigap and Part D, along with some insights into ala carte options for additional benefits.

Advantages of Original Medicare + Medigap + Standalone Prescription Drug Plan (PDP)

1. Predictable Costs and Comprehensive Coverage

   • Medigap Coverage: Medigap (Medicare Supplement Insurance) policies fill in “gaps” by covering out-of-pocket expenses like deductibles, copays, and coinsurance that Original Medicare doesn’t cover. This means more predictable costs, especially if you require frequent medical services.

   • Flexible Access to Providers: With Original Medicare and Medigap, you can see any doctor or specialist across the country who accepts Medicare, without the network restrictions you often find in Medicare Advantage plans.

   • Standalone Prescription Drug Plan (PDP): By adding a standalone Part D plan, you can tailor prescription drug coverage to your needs without bundling it with other benefits, giving you the flexibility to choose a PDP that covers your specific medications at an affordable cost.

2. More Control Over Coverage Choices

   • By combining Original Medicare, Medigap, and a PDP, you can build a package that best meets your individual needs, especially if you’re focused on flexible access to providers and comprehensive medical and drug coverage. If a Medigap plan covers your hospital and medical costs well, and your Part D plan covers your medications, you may avoid surprise expenses.

3. Freedom from Network Restrictions

   • Unlike Medicare Advantage plans, which typically limit access to providers within specific networks, Original Medicare with Medigap allows beneficiaries to see any Medicare-approved doctor nationwide. This is especially valuable if you travel frequently or have doctors in different regions.

4. Lifetime Coverage with Medigap

   • Once you enroll in a Medigap plan, you’re generally allowed to keep it as long as you continue to pay the premium. This stability can be beneficial if you develop health conditions that might limit other plan options later in life.

Disadvantages of Original Medicare + Medigap + Standalone Prescription Drug Plan (PDP)

1. Higher Premiums

   • Medigap Premiums: Medigap plans can be expensive, especially if you select a comprehensive plan like Plan F or Plan G, which offer extensive coverage. Monthly premiums may be higher than those in Medicare Advantage plans, particularly if you add a separate PDP premium.

   • Separate Premiums for PDP: With this setup, you pay separate premiums for Original Medicare Part B, your Medigap plan, and a Part D prescription drug plan, which can add up.

2. No Built-In Extra Benefits

   • Original Medicare and Medigap plans don’t cover dental, vision, hearing, or fitness memberships—benefits often included in Medicare Advantage plans. You’ll need to seek out additional ala carte plans if these services are important to you.

3. Complexity of Multiple Plans

   • Since you’re combining multiple plans, it can be confusing to manage each policy, understand how they work together, and ensure you’re staying within each plan’s guidelines. There may also be different customer service contacts and billing departments, which can be inconvenient.

4. Limited Prescription Drug Coverage in Medigap

   • Medigap policies no longer cover prescription drugs (this stopped in 2006). Therefore, you must enroll in a separate Part D plan, which requires additional research and management. Additionally, if you don’t enroll in a Part D plan when you’re first eligible and decide to add it later, you may face a late enrollment penalty.

Ala Carte Options for Dental, Vision, Hearing, and Gym Memberships

If you choose Original Medicare with Medigap and a standalone PDP, you’ll need separate plans for dental, vision, hearing, and fitness if you want these benefits. Here’s a breakdown of the options:

1. Dental Insurance or Discount Plans

   • Insurance: Standalone dental insurance is available from many insurers, covering routine exams, cleanings, and, in some cases, more extensive procedures like crowns or dentures. However, these plans often come with limited annual maximums and waiting periods for major services.

   • Dental Discount Plans: Another option is a dental discount plan, which isn’t insurance but provides discounts on dental services for a small annual fee. If you primarily need coverage for routine services, this may be a cost-effective alternative.

2. Vision Insurance

   • Vision insurance plans typically cover eye exams, corrective lenses, and sometimes discounts on frames or contact lenses. Plans vary, so check for coverage on specific needs like progressive lenses or multi-focal contacts.

   • Alternatives: Some optical retailers offer memberships or discounts that provide savings on exams and eyewear without requiring insurance.

3. Hearing Insurance or Discount Programs

   • Standalone Hearing Plans: Some insurers offer hearing plans that cover exams, hearing aids, and fittings. Hearing aids can be expensive, so this may be worth considering if you need them.

   • Hearing Discount Programs: There are also discount programs that provide savings on hearing aids and related services. Some big-box retailers, like Costco, offer hearing aids and services at competitive prices, which may be a cost-effective option without insurance.

4. Gym Memberships

   • While some Medicare Advantage plans include gym memberships through programs like SilverSneakers, beneficiaries on Original Medicare can still access fitness programs in other ways. Some Medicare Supplement plans offer access to wellness programs, or you can purchase a standalone gym membership.

   • Fitness Programs: Certain gyms and community centers offer senior discounts or health-oriented programs. Check with local gyms to find out about reduced rates for older adults, or explore community centers for free or low-cost classes.

Is Original Medicare + Medigap + PDP Right for You?

This setup is ideal for individuals who value flexibility, have extensive medical needs, or want the peace of mind that Medigap provides by covering most out-of-pocket expenses. Original Medicare with Medigap allows beneficiaries to see any provider that accepts Medicare, making it a great choice for frequent travelers and those who want unrestricted access to specialists.

However, it’s not the most affordable option for everyone, especially if your priority is cost savings. The premiums for Medigap and PDPs can be higher than Medicare Advantage, and you’ll need to purchase additional coverage if you want dental, vision, hearing, or fitness benefits. If you’re looking for more bundled, low-cost coverage, Medicare Advantage might be a more convenient option.

Final Thoughts

Choosing Original Medicare with a Medigap plan and a standalone Part D plan gives you control over your healthcare coverage, offering comprehensive protection and flexibility without the network restrictions of Medicare Advantage. However, the out-of-pocket costs and lack of built-in extra benefits mean that it’s essential to budget carefully and plan for separate coverage if you need services like dental, vision, hearing, or fitness.

Ultimately, the decision should reflect your healthcare priorities, lifestyle, and budget. If the freedom to see any Medicare provider nationwide is essential to you and the premium costs are within your budget, Original Medicare with Medigap and PDP can be a great fit. For those looking to add on “extras,” ala carte options can help you round out your coverage, ensuring that you have access to the services you value most.