What Original Medicare Covers and Doesn’t Cover – And How to Fill in the Gaps

Navigating Medicare can feel overwhelming at first, especially when you're trying to figure out what’s covered, what’s not, and how to make sure you're fully protected. Let’s break it down in simple terms so you can make smart choices about your healthcare. Need help navigating these decisions? Our team can help you, for free!

What Is Original Medicare?

Original Medicare is the government-run health insurance program for people 65 and older (and some younger individuals with disabilities). It’s made up of two parts:

• Part A (Hospital Insurance):Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

• Part B (Medical Insurance):Covers doctor visits, outpatient care, medical equipment, preventive services, and some home health care.

Together, Parts A and B cover many essential health services. But they don’t cover everything — and those gaps can be costly.

What Original Medicare Doesn’t Cover

Here’s where things get tricky. Original Medicare does not cover:

• 80/20 rule with no maximum out of pocket: there is some nuance here, but you are liable for 20% of the cost of your care indefinitely with no stop loss.

• Prescription drugs (you’ll need a separate Part D plan)

• Dental care

• Vision exams and glasses

• Hearing aids

• Long-term care (custodial care in nursing homes)

• Overseas emergency coverage

• Routine foot care or chiropractic care (with some exceptions)

Also important: Original Medicare has no annual out-of-pocket maximum, which means there’s no cap on how much you could spend in a bad health year.

How to Fill in the Gaps

To protect yourself from surprise costs and get more complete coverage, many people add extra layers to their Medicare:

1. Medicare Supplement Insurance (Medigap):

• Helps pay out-of-pocket costs like deductibles, copays, and coinsurance.

• You can see any doctor that accepts Medicare — no networks.

• Doesn’t include prescription drug coverage (you’ll still need a Part D plan).

2. Medicare Advantage Plans (Part C):

• An alternative to Original Medicare offered by private insurance companies.

• Often includes drug coverage, dental, vision, hearing, and more.

• Typically has lower premiums but includes provider networks and copays.

3. Prescription Drug Plan (Part D):

• Helps cover the cost of medications.

• Must be purchased separately if you stay with Original Medicare.

  
  

Bottom Line

Original Medicare provides a solid foundation — but it wasn’t designed to cover everything. That’s why most people choose to add either a Medigap policy + Part D or enroll in a Medicare Advantage Plan.

Need help figuring out what’s best for you?

Our team specializes in guiding people through the Medicare maze with kindness, clarity, and zero pressure. We’re here to help you make confident, informed decisions — and avoid expensive mistakes.