Key Takeaways

• In 2025, it is still possible to rely solely on Original Medicare (Part A and Part B), but doing so means accepting significant coverage gaps and out-of-pocket expenses.

• Choosing not to add extra coverage such as prescription drug plans or Medigap may leave you financially vulnerable, especially in the event of unexpected hospital stays or long-term outpatient care.

Understanding What Original Medicare Covers

Original Medicare includes two main parts:

• Part A (Hospital Insurance): This covers inpatient care in hospitals, skilled nursing facility care (after a qualifying hospital stay), hospice care, and limited home health services. Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes for at least 40 quarters.

• Part B (Medical Insurance): This covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health care. In 2025, the standard monthly premium for Part B is $185, with an annual deductible of $257.

While these two parts provide broad coverage, they don’t cover everything. Without any add-ons, your healthcare experience may involve considerable out-of-pocket expenses and limitations.

What’s Missing If You Only Stick With Original Medicare

You might assume Medicare takes care of all your health needs, but that’s not quite the case. Here’s what Original Medicare does not cover:

• Prescription Drugs: Original Medicare does not cover most outpatient prescription medications.

• Routine Vision, Dental, and Hearing Services: Regular eye exams, glasses, dental cleanings, dentures, hearing aids, and exams are generally not covered.

• Long-Term Custodial Care: If you need help with daily activities over an extended period—like in a nursing home—Medicare does not cover these costs.

• Excess Charges: Some providers may charge more than Medicare’s approved amount. Without Medigap, you pay the difference.

• Foreign Travel Emergencies: Original Medicare generally doesn’t cover healthcare services outside the United States.

Sticking solely with Original Medicare leaves you with these coverage gaps unless you pay out of pocket or purchase supplemental insurance.

Out-of-Pocket Costs Without Add-Ons

If you’re relying only on Original Medicare in 2025, you’re responsible for several potential out-of-pocket expenses:

• Hospital Deductible: $1,676 per benefit period for Part A.

• Coinsurance for Hospital Stays: After 60 days, you pay $419 per day, and after 90 days, $838 per day using lifetime reserve days.

• Skilled Nursing Facility Coinsurance: After 20 days, you pay $209.50 per day up to day 100.

• Part B Cost Sharing: After the $257 deductible, you usually pay 20% of the Medicare-approved amount for services.

These costs can add up quickly, especially if you require frequent outpatient treatments or unexpected hospital stays.

Why Some People Still Choose Original Medicare Alone

Despite the risks, some beneficiaries do opt to remain with just Original Medicare. Common reasons include:

• Simplicity: Original Medicare does not require network restrictions, referrals, or plan shopping.

• Provider Access: You can visit any doctor or specialist that accepts Medicare nationwide.

• Temporary Health Needs: If you are in good health and don’t anticipate high costs, you may feel it’s sufficient for now.

• Financial Limitations: Some may avoid additional premiums by declining supplemental coverage.

However, this choice often comes with a gamble—one serious medical event can shift the financial balance dramatically.

What About Prescription Drug Coverage?

One of the biggest limitations of Original Medicare is its lack of prescription drug coverage. If you decide to skip adding a standalone drug plan (known as Part D), you’ll need to pay the full cost of most medications out of pocket.

This can become particularly expensive for those managing chronic conditions or who take multiple daily prescriptions. In 2025, Part D plans have a $2,000 out-of-pocket cap on drug costs, but this benefit only applies if you actually enroll in a Part D plan.

If you delay enrolling in Part D and don’t have other creditable drug coverage, you may face late enrollment penalties that increase your monthly premium permanently if you decide to enroll later.

What About Medigap Policies?

Medigap plans are sold by private companies and help cover some of the costs not paid by Original Medicare. These might include deductibles, coinsurance, and even foreign travel emergency coverage.

If you skip a Medigap plan when first eligible and later decide you want one, you may face medical underwriting—meaning you can be denied or charged more based on your health history. The initial 6-month Medigap enrollment window begins when you’re both 65 and enrolled in Part B.

By opting out of Medigap during that window, you limit your options down the line if your health status changes.

Are Preventive Services Covered?

Yes. Original Medicare does provide coverage for many preventive services, including:

• Annual wellness visits

• Screenings for cancer, diabetes, and heart disease

• Flu and pneumonia shots

• Depression screenings

These services are typically covered with no cost to you if you meet the eligibility criteria and receive them from a Medicare-approved provider.

However, follow-up diagnostic services are not always fully covered, and coinsurance may apply.

Does Original Medicare Limit Your Out-of-Pocket Spending?

No, and this is a critical consideration.

Original Medicare does not include an out-of-pocket maximum. That means there’s no annual cap to stop your medical costs from snowballing. If you experience a major illness or require long-term outpatient treatments, your 20% coinsurance could become a significant burden.

By contrast, certain other Medicare options include annual out-of-pocket limits. If financial predictability is important to you, this is a major reason to consider supplemental options.

Timing and Enrollment Considerations

If you’re newly eligible for Medicare in 2025, you have a 7-month Initial Enrollment Period (IEP):

• It begins 3 months before your 65th birthday month

• Includes your birthday month

• Ends 3 months after your birthday month

During this time, you can enroll in Part A, Part B, and add any other coverage like Part D or Medigap.

If you only enroll in Original Medicare and later wish to add Part D or Medigap, you might face delays, penalties, or underwriting.

Annual Medicare Open Enrollment from October 15 to December 7 allows changes to drug coverage or to switch from Original Medicare to another Medicare option. But if you’re only on Original Medicare and decide to change outside of this window, your choices may be restricted.

Is It Ever Advisable to Stay With Just Original Medicare?

In rare cases, yes. If you:

• Have employer or union-sponsored retiree coverage that fills the gaps

• Qualify for other government assistance programs that supplement Medicare

• Rarely visit doctors and don’t take regular medications

Then Original Medicare alone might be sufficient. But these situations are exceptions rather than the rule.

For the majority of beneficiaries, the coverage limitations and lack of spending protection make Original Medicare alone a risky choice.

A Closer Look at 2025 Policy Updates

There are a few 2025-specific changes worth noting:

• The Part B premium has increased to $185, and the deductible is now $257.

• Part A inpatient hospital deductible has risen to $1,676 per benefit period.

• Part D out-of-pocket cap of $2,000 is now in effect, but only if you’re enrolled in a plan.

These changes make the idea of forgoing supplemental coverage even more financially precarious than in previous years.

Weighing Your Options Carefully in 2025

If you’re approaching Medicare eligibility or re-evaluating your coverage in 2025, sticking with just Original Medicare may appear appealing for its simplicity and flexibility. However, the risks—from high out-of-pocket costs to lack of drug coverage—are substantial.

Reviewing your full medical needs, financial situation, and future expectations is essential before deciding to skip additional coverage.

Consider the Full Picture Before Deciding

Relying solely on Original Medicare in 2025 is possible, but it often comes at a cost—literally. You face no annual out-of-pocket limit, gaps in services like dental and vision, and no drug coverage unless you add it separately. While some may still find this setup adequate, it’s important to know what you’re giving up.

If you’re unsure whether Original Medicare alone meets your healthcare needs, speak with a licensed agent listed on this website for personalized advice.