I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?

Question

Comfort Olude · Accepted Answer

The Original Medicare ( Part A and Part B) only covers part of your healthcare costs. Beneficiaries must enroll in supplemental insurance plans to cover prescription drug costs, deductibles, co-pays, co-insurance, and the lack of a yearly out-of-pocket limit.

The coverage gaps include prescription drug coverage, you can enroll in a stand-alone Part D drug plan.

Other gaps are routine vision, dental, and hearing. Consider enrolling in a Medicare Advantage plan. These plans are an alternative way to get the Original
Medicare, Part A, Part B, and additional benefits.

Gary Church · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/i-just-enrolled-in-medicare-and-ive-got-my-part-a-and-b-but-im-hearing-there-are-gaps-in-coverage-what-are-these-gaps-exactly#gary-church

Mike Alexander · Answer

If you just only have A& B , then you have a Hospital Admission deductible and a part b deductible.
Medicare will pay 80% and you pay 20%  of charges
If you have a Medigap plan then it will pick up the 20% after a $280 ded.

Norman Smith · Answer

Medicare itself, through Parts A & B covers only 80% of the costs associated to your Medical needs. This DOES NOT include your Co-pays, deductibles, co-insurances that would also apply at different times. These are the gaps! 
For example, simply being admitted to the hospital, generates a bill of $1676 to you on its own. Other charges that come directly from a Doctor, an Anesthesiologist, or X-rays, CR Scans, etc. will create another bill on top of that!
So a Medigap plan picks up the differences, lessening any other costs that you would otherwise be responsible for. 
Still, if given the choice, I will emphasize that Original Medicare with the best available Supplement or Medigap plan, would be the best way to protect yourself in your Senior years.

William Lawler · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/i-just-enrolled-in-medicare-and-ive-got-my-part-a-and-b-but-im-hearing-there-are-gaps-in-coverage-what-are-these-gaps-exactly#william-lawler

Bill Wheeler · Answer

Original Medicare (Parts A and B) doesn't cover prescription drugs, routine dental, vision, or hearing care, long-term care, or many routine physical exams.

Tony Capraro III · Answer

Medicare agents hub, you have questions? We have answers. Tony Capraro, State Farm, Kelly Street in Manchester, New Hampshire. I just enrolled in Medicare. I've got my Part A and Part B, but I'm hearing there are gaps in coverage. What are these gaps exactly?

Well, to start off, Part A has a deductible, the hospital piece, of $1,692. And that will increase in 2026. Part B, the government pays 80% of the cost to the doctors in patient, all your exams, tests, etc. They'll pay 80%, and you'll pay the 20%. But there is no maximum out-of-pocket on that 20%. So there's a massive gap.

What you really should do is sit down with someone who does Medicare planning on a daily basis, like myself or these other fine folks on Medicare Agents Hub, and go through it. What makes sense for you? What makes sense for your family? What your goals and objectives are? And then you can put together a plan, whether it's a Medicare supplement added to Parts A and B or a Medicare Advantage plan, commonly called Part C, which includes Part B and your drug prescriptions. So work with someone like myself.

Edward Smith, ChFC, CRPS, AIF · Answer

For 2026 here are your responsibilities (out of pocket cost). 

Part A deductible: There is a $1,736 deductible for inpatient hospital care.
Then Medicare part A pays 80% and you are responsible for 20% for 60 days. If you are still hospitalized on the 61st day, you start paying a $434.00 per day coinsurance. If you get out of the hospital a then get re-admitted after a 60-day gap of not being hospitalized, these charges can start over.

Part B Deductible: The annual deductible for part B services is $283. Then Medicare pays 80% ad you are responsible for 20%.
There is not an out-of-pocket maximum. You are responsible for 20% of Whatever unless you have a Medicare Advantage plan which caps the maximum or a Medicare supplement which pays all medical expenses except the $283 part B deductible.

Jonathan Potter · Answer

So think of Medicare A and B as basic coverage. There will be a deductible and then you will have to pay a percentage of the cost. This changes every year. Medicare doesn't provide any type of dental, vision, hearing or drug coverage. Because of this many people buy supplements or enroll in medicare advantage.

Answered by Jonathan Potter on August 19, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Christy Jones · Answer

Part A and Part B will cover 80% of Medicare covered services. You should meet with a trusted Broker to see what your options are to cover the other 20%. Also, you’ll want to make sure to get enrolled in a Prescription Drug Plan so you have prescription coverage. (Even if you don’t take any prescriptions, you need to have prescription coverage.) If you go longer than 63 days without ‘credible prescription coverage’, you will receive a lifetime late enrollment penalty.

Answered by Christy Jones on August 19, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Nick Mangini · Answer

Yes there are gaps in Original Medicare coverage such as the 20% coinsurance and deductibles. This is why we recommend getting a Supplement (Medigap) Plan which covers most of these expenses, so it eliminates your responsibility to pay the costs. Plan G and Plan N are the best Medigap plans

Answered by Nick Mangini on October 11, 2025

Broker Licensed in FL, AL, AZ & 32 other states

Answered by Nick Mangini Medicare Insurance Agent

Kerwyn Jones · Answer

1. Long-Term Care
2. Routine dental, vision & hearing
3. Prescription Drugs
4. Foreign Travel
5. Excess Charges

Luke Rhoads · Answer

Prescription Drugs, dental vision hearing, and long term care aren't covered. There is a part A deductible ($1676) for inpatient hospital stays and $419 per day copay for days 61-90 and $838 per day for days 91-150 (lifetime reserve days). Part B has a deductible of $257 and then it is 80%-20% coinsurance for outpatient services. Meaning the medicare benficiary pays 20% of all outpatient services with no cap.

Answered by Luke Rhoads on July 2, 2025

Broker Licensed in OK

Answered by Luke Rhoads Medicare Insurance Agent

Paul Potter · Answer

No insurance covers everything - Medicare included. Medicare pays specified amounts for classifications of care and you pay the difference. And, importantly, with Medicare, you do not have a limit of liability. This is why people purchase Medicare Supplement or Medicare Advantage plans.

Answered by Paul Potter on September 23, 2025

Broker Licensed in FL

Answered by Paul Potter Medicare Insurance Agent

Carly Cusack · Answer

When you sign up for Original Medicare it covers 80% of your medical costs. This leaves 20% of your medical costs coming from your pocket. People might consider this a gap in coverage but I consider it a financial risk. Also, Original Medicare only covers your Part A and Part B. You don't have dental, vision or hearing coverage with Origninal Medicare.

Answered by Carly Cusack on January 5, 2026

Broker Licensed in OR & WA

Answered by Carly Cusack Medicare Insurance Agent

Mark Cunningham · Answer

The gaps come from Cost Share for Part A, Deductible of $257 and co insurance of 80/20% for Part B. In Part B you are responsible for 20% of the cost which is open ended. This means there is no maximum out of pocket. An example is a $60,000 hospital bill. You would be responsible for 20% or $12,000 of this cost. Provided everything billed is an accepted Medicare expense. I would be happy to go into this in more detail, please call me for further information.

Answered by Mark Cunningham on March 31, 2025

Agent Licensed in CO, FL, GA & NE, VA, WI & WY

Answered by Mark Cunningham Medicare Insurance Agent

Ravi Natarajan · Answer

The Gaps are Part A deductible, Part B deductible and 20% co-insurance and finally no coverage for Prescription Drugs that you pick up at a Pharmacy.

Esther Miller · Answer

The most common misconception most people have is that Medicare will cover all your Medical needs 100%. This is not true, in most cases. Medicare parts A and B, has co-pays and dedu tables, including a deductible of around $1700 for hospital coverage, and $283 for part B coverage, after that Medicare pays 80% but you will still be responsible for 20% of the bills. This is why you will want to consider the pros and cons of adding either a Medigap Supplent + prescription drug plan or a Meficare Advantage plan that includes prescription drug coverage.

Answered by Esther Miller on January 19, 2026

Agent Licensed in WA

Answered by Esther Miller Medicare Insurance Agent

David Wynne · Answer

Original Medicare (Parts A and B) covers many basic health services but leaves several important gaps. There’s no annual out-of-pocket maximum, so you could end up paying a lot if you need extensive care. You’re also responsible for deductibles and 20% coinsurance on most services.

It doesn’t cover routine dental, vision, or hearing care, and it excludes most outpatient prescription drugs unless you add a separate Part D plan. Long-term care and medical services outside the U.S. are also not covered.

To help with these gaps, many people choose a Medigap policy or a Medicare Advantage (Part C) plan, which can include extra benefits and limit your out-of-pocket costs.

By working with a Licensed Local agent like myself, we can talk through the options that are available so you can make an informed decision.

Michael Wehner · Answer

The question is, I just enrolled in Medicare and I've got my Part A and Part B, but I'm hearing there are gaps in coverage. What are these gaps exactly?

So, your original Medicare, which is your Part A and Part B, does not cover everything. Part A is primarily for hospital services, and Part B is primarily for your outpatient services. So, what does that not cover?

First of all, your Part A and Part B do not address prescription drugs. You would address prescription drugs by purchasing a separate standalone drug plan, often called Part D, or a Medicare Advantage plan that includes prescription drugs. That's referred to as Part C.

In addition, your Part B, which covers your outpatient services, only covers those things at 80%, with no out-of-pocket limit. And then, on your Part A for hospitalization, you have a deductible that you have to meet. Your Part A also limits the number of lifetime days that you can ultimately stay in the hospital.

So, someone who just has their original Medicare, their Part A and their Part B, realistically has unlimited out-of-pocket exposure without purchasing additional coverage, such as a Medicare Advantage plan or a Medicare supplement plan with a prescription drug plan. Hopefully, that answers your question.

Joanna Finnegan · Answer

When you have Medicare A and B and no other coverage, you will be responsible for high deductibles, copayments, and coinsurance with no maximum out-of-pocket limit. This means that there is no cap on what you could pay out-of-pocket for the year in medical copays and coinsurance. You can either choose a Medigap (Supplement) plan or Medicare Advantage plan to help fill the gaps in Medicare. You also want to make sure you have Part D to cover prescriptions. There is a penalty if you don't sign up for Part D when you are first eligible. If you have more questions, call me. I can go over your options with you and help you enroll in the plan that is best suited for you. ~Joanna Finnegan

Answered by Joanna Finnegan on August 20, 2025

Broker Licensed in ID, AR, AZ & 31 other states

Answered by Joanna Finnegan Medicare Insurance Agent

Donna Berube · Answer

The reason that most people enroll in a Medicare Advantage plan or a Medigap with an added prescription drug plan is because of the gap in coverage. if someone ends up in the hospital the client is responsible for $1,676 deductible per benefit period, Medicare will pay for the first 60 days of each benefit period, and from days 61-90 the client will pay $419.00 per day. There is a lot of exposure on original Medicare, which is why people will add a Medicare Advantage plan with low or $0 premiums or a Medigap with an added prescription drug plan.

Answered by Donna Berube on September 9, 2025

Agent Licensed in NH

Answered by Donna Berube Medicare Insurance Agent

Wagdy Saadalla · Answer

Medicare cover only 80% after you satisfy your deductible.
There is deductible for part A $1,632 for 2025 but for 2026 has not been released, and Part B deductible $257 for 2025 and $288 for 2026.
For Medicare Supplement or (MedGap) there are plans from A to N this plans has been designed by Medecare, this plans are the same in every company, the difference is the name of the company and the price tag. When you get the Medicare supplement, you have to buy a prescription drug.
Plan G had only part B deductible, once has been satisfied you do not pay any co-pay or insurance, as long as the service has been provided to you covered by Medicare the insurance company will cover the remaining.
Plan N has Part B deductible, $20 copay for doctors, & $50 gor ER.
 PLAN N will not cover Part B Excess charge , but Plan G will.
The Excess charges can go up to 15%.
Plan N is more affordable than Plan G.

Robert Reed · Answer

If you have Medicare‘s with parts an and B then you are exposed to 20% of all cost. Medicare part A and part B only covers 80% of the expense for doctors and hospitals.

Brenda Trejos · Answer

Well the gaps exist because your Medicare coverage is basically an 80/20 Health plan with no Max of of pocket (MOOP) limit.  That could be a very expensive situation if you have to pay 20% of a large hospital or medical bill, again with no cap or MOOP.  
You would be much better off reaching out to an Agent/Broker that can help you find the best coverage & search different Companies for your situation and can help protect you from having to possibly pay $1000's of dollars with no limit.  
Your Agent/Broker is there to guide you and should do so without obligation or cost to you from them.

Ali Crouch · Answer

For 2025, the following is what Medicare leaves behind and is your responsibility:

MEDICARE PART “A” Hospital (Room & Board, Hospice, Blood, Misc. Services & Supplies)
1-60 Days: $1,676 Deductible
61-90 Days: $419 Per Day
91-150 Days: $838 Per Day
Skilled Care Following Hospital Stay
1-20 Days: $0 Per Day
(3 midnights in Hospital, 30 days after leaving, improving)
21-100 Days: $209.50 Per Day
100+ days: 100% of the bill is the patient's responsibility
MEDICARE PART “B” Medical (Dr. visits, ER, lab, x-ray, Medical supplies, etc.)
Cost: 185- can be lower or higher/income-based
Deductible: $257
80% Medicare/20% Insured or Co-Insurance
*Original does not cover dental, vision, or hearing*

The consumer still has to obtain drug coverage or "Part D"; there are also Medicare Advantage Plans or "Part C" that have different costs involved. 

Please don't hesitate to contact us if you have any questions or would like a more detailed explanation. 
Ali Crouch
Contact me.

Joel McKinney · Answer

Part A (hospitalization) has a deductible associated with it for days 1-60 of being admitted. Days 61-90 have a per day copay. Days 90+ have a higher per day copay. Part B (medical insurance) has a deductible as well. After you pay that, Medicare pays 80% and you pay 20%. Finally, original Medicare does not usually cover vision, hearing, dental, or pharmacy drug costs.

Answered by Joel McKinney on March 10, 2026

Agent Licensed in WV

Answered by Joel McKinney Medicare Insurance Agent

Tom Rogala · Answer

Part A & B cover 80% of dr and hospital only.  Most, pick a medigap or advantage plan to cover the other 20% and prescription drugs

Evan Hountz · Answer

There is no maximum limit on what you could owe under parts A and B. To make your plan more like a traditional health insurance plan, you could purchase a Medi-Gap plan or possibly a Medicare Advantage Prescription Drug plan

Answered by Evan Hountz on January 21, 2026

Broker Licensed in OH, FL, IN, KY & TX

Answered by Evan Hountz Medicare Insurance Agent

Wade Lashley · Answer

For Part A (Hospital insurance) there is a $1,676 deductible if you're admitted as an inpatient. You could be responsible for additional charges if you had a hospital stay of 61 straight days or more. 
For part B (Medical services) you are responsible for the deductible of $257. Once the deductible is met Medicare covers 80% of the approved charge and you would be responsible for the remaining 20% whether the bill is $100 or $100,000, 

Purchasing a Medigap plan or enrolling in a Medicare Advantage plan can help you reduce your out of pocket costs. Speak with a local Agent for more info on all of your options.

Alyssa Burgos · Answer

When you only have Part A and B, you have no stop loss. You can be charged a lot of excess charges. Original Medicare doesn't cover 100% of your costs. You're responsible for deductibles, copayments, and coinsurance after Medicare pays its share. Part A and B alone do not have an annual maximum out-of-pocket limit. If you have a serious illness or need extensive care, your expenses could be very high. Original Medicare (Parts A and B) does not include prescription drug coverage.

Answered by Alyssa Burgos on September 29, 2025

Broker Licensed in CO, AZ & TX

Answered by Alyssa Burgos Medicare Insurance Agent

Jeremy Purse · Answer

Without enrolling in a Medicare Advantage or Supplement Plan, you will have to pay the Part A Deductible when admitted to the hospital which is $1,676. You will also have to pay 20% for all of your outpatient procedures covered under Part B. When you are enrolled in a Medicare Advantage or Supplement plan, it will typically cover all of those out of pocket costs.

Answered by Jeremy Purse on May 14, 2025

Broker Licensed in CA, AL, AZ & 5 other states

Answered by Jeremy Purse Medicare Insurance Agent

Corey Schuler · Answer

There are many gaps when it comes to having Original Medicare coverage. For one, Original Medicare does not include drug coverage. Additionally, there is no coverage extension if you are traveling outside the US. In addition, there is no dental, vision or hearing coverage. And lastly, there are many holes when it comes to deductibles, co-insurance, and copays. For these reasons, I like to present my clients with multiple coverage options, so that they are not left with any gaps in their health insurance.

Answered by Corey Schuler on July 28, 2025

Broker Licensed in TX, AL, AR & 10 other states

Answered by Corey Schuler Medicare Insurance Agent

DeVin LeMay · Answer

Original Medicare doesn’t cover everything — you’ll still pay deductibles, coinsurance, and have no cap on out-of-pocket costs. It also excludes most dental, vision, hearing, and long-term care, which is why many add Medigap or Medicare Advantage plans for extra protection.

Answered by DeVin LeMay on November 3, 2025

Agent Licensed in MA

Answered by DeVin LeMay Medicare Insurance Agent

Kent Arrington, FICF, CSSCS · Answer

The gaps in Medicare are actually too numerous to list here. 
You can go to the website listed below to see what the actual gaps are and how they may affect you.
In my opinion, it would be in your best interest to actually sit down with a local broker and go over these gaps, and discuss ways you can avoid having to pay them. Take the time to be proactive and do your research. 

https://www.medicare.gov/basics/costs/medicare-costs

Missy Nevin · Answer

Original Medicare alone does not cover everything. For example, with Part A you have a large deductible and copays for extended stays in a hospital or skilled nursing facility. With Part B, Medicare typically pays 80% for outpatient services, and you are responsible for the remaining 20%. There is no cap on what you could spend out of pocket. That is why I recommend either a Medicare Supplement or a Medicare Advantage plan to fill in these gaps.

Answered by Missy Nevin on April 27, 2026

Broker Licensed in FL

Answered by Missy Nevin Medicare Insurance Agent

Peter Herlevi · Answer

There are a number of gaps in original Medicare (Parts A and B). These gaps are the exact reason to consider private insurance in addition to or in lieu of original Medicare - to manage one's exposure to these gaps.

These gaps include deductibles (specific $ amounts the insured pays before Medicare pays), copays (specific $ amounts the insured pays for specific services, usually after a deductible is met and certain coverage limits have been exceeded) and coinsurance (a % of the Medicare allowable charge for specific services that the insured is responsible for, again usually after a deductible is met). There are a few other uncommon gaps, in the form of coverage limits and excess allowable charges.

This topic can get a bit involved, as these gaps are different and specific for Part A vs Part B, and the $ amounts of deductibles and copays typically change each calendar year.

In general - this is not intended to be exhaustive - these are the gaps in original Medicare:

Part A has a deductible that potentially can be incurred more than once per calendar year. This deductible is not exactly incurred per inpatient hospital admission, but it can be thought of in roughly those terms. For long inpatient hospital stays or rehabilitation stays in a skilled nursing facility or nursing home, Part A has daily copays after these respective types of stays have reached a certain length. Part A also has maximum lengths for these respective types of stays (these maximums are quite long and it is rare, but not unheard of, for one to have a stay that exceeds these maximums).

Part B is somewhat simpler, in that it has an annual deductible and once that annual deductible is met, the insured is generally responsible for a coinsurance % of the Medicare allowable charge for a given service. Unlike the Part A and Part B deductibles and copays, which historically have changed virtually every calendar year, the Part B coinsurance % has remained at 20%.

Steven Bleicher · Answer

There used to be a gap called the “doughnut hole” regarding drugs. With the Inflation Reduction Act of 2023/24, this has changed. That gap has been fully eliminated in favor of a maximum out of pocket cost of $2,000.00 per year for all of your drugs, both generic and brand name. The next new year, it will begin all over again.

Answered by Steven Bleicher on May 25, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

So Medicare Part A covers generally 80% of Medicare approved Hospital costs, leaving you with a 20% liability. Medicare Part B generally covers 20% of Medicare approved Medical Expenses leaving you with 20% gap to cover. Please use a Broker. Look into Medicare Advantage for where you reside.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Steve Houchens · Answer

If you choose original Medicare Part A & B coverage the first 80% then you are responsible for the remaining 20% with no cap or stop loss on how much you could be liable for. That’s why you need to choose a Medicare Supplement or Medigap Plan or possibly a Medicare Advantage plan to protect you from potential liability.

Answered by Steve Houchens on October 23, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Timothy Brown · Answer

Some of the gaps in Original Medicare (Part A&B) are as follows:
1. Medicare only covers 80% of approved medical charges. You’re responsible for deductibles and the 20% coinsurance. 
2. Medicare does not provide prescription drug coverage. It’s your responsibility to enroll in a stand alone Part D prescription drug plan or enroll in a Medicare Advantage plan that includes prescription drug coverage.
3. OriginalMedicare has NO out of pocket spending limits which is the reason why additional coverage is a necessity. There are 2 plan options that will help mitigate this situation which are a Medicare Supplement (Medigap) plan with a stand alone Medicare Part  D drug plan or a Medicare Advantage(Part C) plan). Note: You cannot enroll in both plans.

Kristen Skinner · Answer

If you have original medicare you are in charge of paying 20% of your out of pocket costs. This is because Original Medicare pays 80% and you are in charge of the 20%. That is why it is good to add an Advantage plan or supplemental to cover those out of pocket costs.

Answered by Kristen Skinner on October 14, 2025

Broker Licensed in OK

Answered by Kristen Skinner Medicare Insurance Agent

Leslie Kaz · Answer

You’re absolutely right — Original Medicare (Parts A and B) covers a lot, but it doesn’t cover everything. You’re still responsible for deductibles, copays, coinsurance, and there’s no cap on out-of-pocket costs, which can get expensive if you have ongoing care needs. It also doesn’t include prescription drugs, dental, vision, or hearing. That’s why many people add a Medicare Advantage or Medigap plan to help fill those gaps and protect their wallet.

Answered by Leslie Kaz on October 27, 2025

Agent Licensed in CA, AL, AZ & 7 other states

Answered by Leslie Kaz Medicare Insurance Agent

Michael Pyers · Answer

Medicare Part B Coinsurance is 20% of the Medicare approved amount and there is no maximum out of pocket. Medicare does not cover certain procedures i.e. cosmetic surgery, routine dental, routine vision, or hearing aids.

Answered by Michael Pyers on May 6, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

Rick Boyd · Answer

The basic items that A and B do not cover (gaps) are: Dental care, Eye exams, Cosmetic surgery, Chiropractic/Massage therapy, Routine physical exams, Hearing exams /hearing aids, Concierge care, Covered care from a provider who has opted out from Medicare, Long term care. It is important to note that Medicare does not cover all prescribed medications. To have what is called "creditable coverage", purchase a part D medication plan from a private insurance company as soon as you start Medicare. You could be subject to paying a life-time penalty of 1% for each month you do not have medication coverage.

Answered by Rick Boyd on July 2, 2025

Broker Licensed in KY, AZ, CA & OH, TN, TX & UT

Answered by Rick Boyd Medicare Insurance Agent

Walt Smith · Answer

There are a lot of gaps you really need to sit down with a broker who understands it in detail and then show. 

For example, the first day you go into the hospital, there’s roughly a $1600 deductible  God forbid you’re in the hospital for more than 60 days then it’s roughly $400 a day co-payand  after 90 days it’s about $800 a day co-pay. 

Under your Medicare part B  an annual deductible of close to $300 not bad but then Medicare pay 80% you pay 20%. Not that you have just say single opposite but if you get in the hospital and getting an knee replacement or a hip replacement can cost you $10,000 out of your pocket.  

You really need something that goes with Medicare to fill in the gaps.

James Stang · Answer

Medicare Parts A and B only cover 80% of your medical costs. You can purchase a Medicare Supplement or enroll in a Medicare Advantage Plan to mitigate the risk of having to pay 20% of your medical bills. 

Medicare does not provide for prescriptions, dental vision or hearing issues. All can be covered by buying additional coverage if you choose.

Chad Watkins · Answer

What does Medicare cover and not cover? To answer this question, we need to take a look at the two different parts of Medicare. Medicare has Part A, which is your hospital coverage, and Part B, which is your medical coverage. Typically, people do not pay a premium for Part A unless you did not work for at least 40 quarters within your lifetime. Part A is going to cover your inpatient hospital care, some skilled nursing care, and hospice care. There is a deductible of $1,676 every time you go in the hospital, and if you're there more than 60 days, there is a copay of $419 per day. From day 91 to 150, it goes up to $838 per day, and then after that, you will be paying for everything, as it is not covered.

For skilled nursing facility care, Medicare will cover you for the first 20 days, and then after that, you pay per day up to day 100. After day 100, you're not covered, so everything would be out of pocket. Your Part B covers your doctor services, your outpatient services, including surgery, and some other services and supplies that are not covered by Part A. There is a premium for your Part B; most people will pay $185 per month, but it does go up based on your income. Part B has an annual deductible of $257, and then after that, 20% is what your coinsurance would be.

Don Golding · Answer

Broadly speaking, Part A covers Hospitalization, skilled nursing confinement, and Hospice. There is a Part A deductible, and copays may apply as well.  Part B also has a deductible and covers roughly 80% of covered expenses.  Additionally, there are no maximum out-of-pocket limits. Neither Part A nor Part B covers prescription drugs - Part D.

I recommend looking at either a Supplemental (Medigap) Plan with a separate Part D prescription plan or an Advantage Care plan with drug coverage built in to cover the "gaps" in original Medicare.

Mal Varlack · Answer

There are things that Original Medicare by itself doesnt cover - hence "gaps". Gaps are: dental, vision and hearing - these are NOT covered by Original Medicare. Prescriptions also are not covered. These would all be seperate coverage that would need to be done.

Answered by Mal Varlack on July 31, 2025

Broker Licensed in FL, AZ, GA & 11 other states

Answered by Mal Varlack Medicare Insurance Agent

David Ryerson · Answer

Yes. Part A has a fairly substantial deductible for being in the hospital that you will have to pay (while on just A&B). Part B has a small deductible but it has 20% coinsurance that you will be billed for, and there is NO LIMIT on that coinsurance. I strongly recommend that you talk to a licensed agent about your options to address these gaps.

Answered by David Ryerson on April 27, 2026

Agent Licensed in AR, KS, MO & OK

Answered by David Ryerson Medicare Insurance Agent

Kathy Detweiler · Answer

Prescription Drug Coverage. Dental, Vision, and Hearing.  Medicare pays 80%, and you are responsible for 20%, so there is no fixed amount for the medical services you receive.

Christopher Garcia · Answer

To put it simply these gaps are either costs that are passed on to you such as deductibles or copays. They can also be services that are simply not covered by original medicare such as Dental, Vision, and Hearing Aid coverage. A good medicare agent can help explain these gaps in more detail and show you solutions to help get them covered if need be.

Answered by Christopher Garcia on March 31, 2025

Broker Licensed in NM, AZ, CO & TX

Answered by Christopher Garcia Medicare Insurance Agent

Gretchen Morris · Answer

Lots of gaps in coverage. A and B are only the federal side of things. I would recommend you meet with a licensed broker who can answer your questions one on one. They are free to use and can really tailor that coverage to what you need.

Answered by Gretchen Morris on February 23, 2026

Broker Licensed in MN, AZ, FL & WI

Answered by Gretchen Morris Medicare Insurance Agent

Hugo Luis Mion · Answer

Medicare does not cover dental and vision. Plus everything has a 20% deductible, but depending on the Medicare Advantage plans, the deductible will be less.

Brian Leichner · Answer

In a nutshell, the Gaps in Medicare are many.  You can fill most of the gaps with either a Medicare Supplement plan or a Medicare Part C (Medicare Advantage) plan.  There are actually gaps with both of those too!  
The gaps in Medicare Supplements include Dental, Vision and Hearing as well as my biggest concern of Skilled Care and Recovery Care.  The gaps in Medicare Advantage include Hospital Copays and Cancer.  
May I suggest spending a little time explaining your concerns so we can tailor a plan for you?  Contact me or email me.

Paul Dzierzanowski · Answer

There are several gaps in Medicare coverage, including: prescription drug coverage; coinsurance and deductibles; foreign travel; routine dental, vision, and hearing; long-term care; and others. To fill these gaps beneficiaries may consider Medicare supplemental insurance or Medicare Advantage plans and other types of senior insurances. To discuss your specific options, feel free to contact me

Answered by Paul Dzierzanowski on April 11, 2025

Agent Licensed in FL & GA

Answered by Paul Dzierzanowski Medicare Insurance Agent

George Kolitsas · Answer

The GAPs in Original Medicare will be the Part A Hospital deducible and Part B Medical 20% that you are responsible for. You can cover these GAPs by purchasing a Medicare Supplemental/MediGap plan offered in your area. Or you can replace Original Medicare with an Medicare Advantage plan that require copays for services as you go to the doctors. These Advantage plans have a Maximum-Out-Of-Pocket that you need to be aware of.

Answered by George Kolitsas on June 9, 2025

Broker Licensed in CT

Answered by George Kolitsas Medicare Insurance Agent

David Treadway · Answer

Here is a condensed listing of the gaps if you were to utilize only original Medicare: https://www.medicare.gov/basics/costs/medicare-costs. You’ll want to manage those costs with either a supplement or an advantage plan.

Answered by David Treadway on June 2, 2025

Broker Licensed in OH, FL, IN & KY, MI, SC & VA

Answered by David Treadway Medicare Insurance Agent

Payal Acharya · Answer

Original Medicare covers 80% , while 20% will be your responsibility . This 20% can end up being a huge burden. Plus , you need to get Part D coverage also. Dental, vision and hearing  are not covered by Original Medicare.
Please reach out for more details.

Trina Knoche · Answer

The major gap with Original Medicare A (which is your inpatient hospitalization) is the $1676 deductible (2025) for the first 60 days of being admitted into the hospital. Each time you go into the hospital for something different, you get another $1676 deductible, which will turn into a daily rate after the first 60 days. The major gap with Medicare Part B (which is all other outpatient services), is that it only covers 80% of all your medical bills. You are responsible for the other 20%. The is also an annual deductible of $257 for 2025. Original Medicare does not cover prescription drugs (which you'll get penalized for if you don't have a plan), long-term care services, and most dental, hearing, vision services, and chiropractic services.

Answered by Trina Knoche on August 4, 2025

Agent Licensed in WA, AK, MT & OR

Answered by Trina Knoche Medicare Insurance Agent

Steven Pomerantz · Answer

Medicare only covers 80% and the gap is 20% and no protection. For example, 20% of cancer. I help guide people with the other options to help.

David Wylly · Answer

Medicare Parts A & B are good but by no means is it complete coverage. There are copayments to use the Hospital and Skilled Nursing under your Part A. Part B covers all of your services and has a negligible deductible. However, after that deductible Medicare only covers 80% and you are left hanging with paying the leftover 20%. Most concerning is that 20% has no stopping point and 20% of everything could be a lot!

Answered by David Wylly on July 23, 2025

Agent Licensed in IL, AZ, CO & 17 other states

Answered by David Wylly Medicare Insurance Agent

Fred Manas · Answer

Medicare coverage gaps refer to the out-of-pocket expenses the subscriber might face beyond what Original Medicare (Part A and B) covers, including deductibles, coinsurance, and copayments. These gaps also encompass areas like prescription drugs, routine vision, dental, and hearing care, as well as some long-term care needs.

Answered by Fred Manas on April 21, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Vachik Chakhbazian · Answer

gaps include prescription drugs, routine dental, vision, and hearing care, and long-term care. To address these, you can enroll in Medicare Advantage (Part C) or Medicare Supplement Insurance (Medigap).

Answered by Vachik Chakhbazian on June 14, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Gary Henderson · Answer

Give me a call and we will over everything with you. This is not a simple one or two sentence answer sadly 
I cover every state except New York and Massachusetts 
My name is Gary Henderson

Mary Brown · Answer

Original Medicare covers many healthcare services, but it does not cover everything. Common “gaps” include deductibles, copays, coinsurance, prescription drugs, dental, vision, hearing, and long-term care. That’s why many people add a Medicare Advantage, Part D, or Medigap plan to help reduce out-of-pocket costs and fill in those coverage gaps.

Answered by Mary Brown on May 19, 2026

Broker Licensed in NJ, DE, FL & NC, OH, PA & TX

Answered by Mary Brown Medicare Insurance Agent

Suzanne Lamperti · Answer

The gaps are; 
Part A you have a deductible and in Part B Medicare only pays 80% of approved charges.. you should enroll in a Medicare Supplement to help offset these charges.

Pat Papson · Answer

This is precisely why it's advisable to have a local agent. I can review potential gaps in Medicare, and help you with ways to fill them.

Cheryl Lyons · Answer

Yes — even with Original Medicare (Parts A & B), there are coverage gaps you should be aware of. Here’s the short breakdown:

1. No prescription drug coverage

Part B covers some medications administered in a doctor’s office, but most prescriptions you fill at a pharmacy aren’t covered.

Solution: Add a Part D prescription drug plan.

2. No routine dental, vision, or hearing

Exams, glasses, hearing aids, and most dental work are not covered.

Some Medicare Advantage plans include limited benefits.

3. Long-term care

Medicare does not cover custodial care (assisted living, nursing home stays beyond short rehab).

Only short-term skilled nursing after hospitalization is covered.

4. Out-of-pocket costs

Deductibles, copays, and coinsurance can be significant.

Part A has hospital deductibles; Part B has a monthly premium and 20% coinsurance for most services.

Solution: Consider Medigap (Supplement) coverage.

5. Limited preventive coverage

Part B covers many preventive services, but some screenings or therapies may require extra approval or cost-sharing.

Bottom line: Original Medicare covers hospital and medical services but leaves gaps in prescriptions, dental/vision/hearing, long-term care, and out-of-pocket expenses.

Sam Silva · Answer

Yes, Medicare Parts A and B have gaps in coverage. They do not cover prescription drugs, dental, vision, hearing, long-term care, or care outside the U.S. You’re also responsible for deductibles, copays, and 20% coinsurance for most services. To fill these gaps, many people choose either a Medicare Supplement plan or a Medicare Advantage plan with extra benefits.

Answered by Sam Silva on June 17, 2025

Broker Licensed in FL, GA, NJ & 7 other states

Answered by Sam Silva Medicare Insurance Agent

Ashley King · Answer

There are gaps in coverage with Original Medicare Parts A&B, such as they do not offer prescription drug coverage, routine dental, vision and hearing, and there is no out of pocket maximum. In addition, Original Medicare does not cover long-term care and may have higher deductibles. There are options to help fill the coverage gap such as Medigap plans, Medicare Advantage and prescription drug plans.

Answered by Ashley King on October 24, 2025

Broker Licensed in MD, AL, AR & 9 other states

Answered by Ashley King Medicare Insurance Agent

Larry Pereiro · Answer

The  real gaps are in the area of ancillary benefits such as dental, vision, prescription drug coverage and even some specific qualifications required to receive coverage from Medicare.
The "gaps" are filled by us of three specific opportunities: Standalone Prescription Drug Coverage, Medigap policies and Medicare Advantage Plans. Medigap only pass if/when Original Medicare pays, and a standalone Prescription Drug Plan is required. A Medicare Advantage Plan which includes the prescription drug plan afford the same coverage as original Medicare but in most cases provides the ancillary benefits. This may sound simple, however, consumers should have access to an educator providing clear and unbiased information on the benefits of each of these options.

Charlie Fitzgerald · Answer

Medicare Part A and Part B do not cover several key areas, including:
Regular dental care: Routine dental services like cleanings and fillings are not covered. 

Vision and hearing care: Eye exams and hearing aids are not included, except for specific conditions. 

Prescription drugs: Most outpatient prescription medications are not covered, and you will need Medicare Part D for that. 

Long-term care: Nursing home stays and assisted living are excluded, although skilled nursing facility care may be covered after hospitalization. 

Care while overseas: Medicare does not cover health services received outside the United States. 


These gaps can lead to significant out-of-pocket expenses, so it's important to consider additional coverage options like Medigap or Medicare Advantage plans to bridge these costs.

Robert Nunn · Answer

The gap coverages are to cover the deductible of par an and part b of Medicare . All companies have to provide the same coverage they don’t have as many ancillary benefits but well worth it

Tony Merwin · Answer

There are deductibles and coinsurance included in both Parts A & B. Additionally certain benefits such as Dental Vision and Hearing is not included.

Part A Hospital Deductible is $1736 per benefit period.
Part B Medical Deductible is $283, and then you have a flat 20% coinsurance after deductible is met.

20% may not sound like alot, but what's important to understand is that there is no maximum out of pocket threshold on that 20% coinsurance.

Maby beneficiaries choose a low cost Medicare supplement plan to help covers these gaps.

Tonya White · Answer

If you only have Original Medicare, it will cover approximately 80% of medical expenses, but there are gaps where you have deductibles for Part A and Part B of Medicare, and it does not cover Part D prescription drug coverage.  There is also no out-of-pocket maximum with Original Medicare so the sky is the limit for what you may be responsible for.  If you don't enroll in a Part D plan, at whatever time you do, or enroll in a plan that includes it, you will have lifetime penalties that are accessed of 1% per month for every month you did not enroll, and you're limited in terms of when you can enroll.  I don't recommend it.

Angela Wainright · Answer

You’re absolutely right—Original Medicare Parts A and B do come with costs. First, there’s a monthly premium for Part B coverage. Additionally, both Part A and Part B have deductibles. Part A’s deductible applies per benefit period, while Part B has an annual deductible. After the Part B deductible is met, you’re typically responsible for 20% of the Medicare-approved amount for covered services (this is called coinsurance).

Diana Muhammad · Answer

Medicare plans are not a one size fits all.  The gap would depend on the need.  Having just Original Medicare (Parts A&B) may be sufficient for one individual.   Someone else may need a supplemental coverage that is not offered, such as Dental and Vision.  It is important to talk to a Broker to discuss comparative plan options. Enrollment periods are approaching.   You should start early to take your time to compare plans prior to a qualifying enrollment period.

Steven Rodriguez Giudicelli · Answer

Original Medicare Parts A and B have coverage gaps, most notably in prescription drugs, routine dental, vision, and hearing care. Additionally, beneficiaries face out-of-pocket costs like deductibles and coinsurance for covered services.

David Fiveash · Answer

Medicare doesn't pay the Part A deductible( $1676.00 in 2026) and other deductible associated with Part A and Medicare doesn't pay the Part B deductible ($283.00 in 2026). After the deductible is met Medicare will pay 80% approved and the beneficiary is responsible for the 20%.

Joni Kattau · Answer

There are a couple of different 'gaps' in traditional Medicare coverage. Medicare A and B does not cover Vision, Dental or Hearing so enrollees either need to purchase separate coverage for these benefits or pay out of pocket for services when they are needed. 

Another considerable 'gap' in Medicare Part B coverage is that there is no annual maximum out of pocket limit. When you are covered by Part B, you have a 20% coinsurance for all services and there is no upper limit on how much you'll pay out of pocket per year like most people have with their employer coverage. If you're healthy and don't see the doctor very often, this 20% coinsurance may not seem to be much of a burden; however, if you are diagnosed with cancer or need a life-saving procedure, the 20% coinsurance can quickly climb 10's of 1,000's of dollars and can quickly deplete any savings you have. 

These are the main two 'gaps' that I educate my clients on when reviewing Medicare parts A & B.

Alisa Mathis · Answer

Medicare only pays 80% for covered services and the Medicare Recipients are responsible for the remainder 20%. There is also annual deductible for part B and a part A deductible that has to be paid by the Medicare recipient every time they are admitted into the hospital. To help with these out of pocket costs some people get a separate insurance policy called a Medicare supplement plan that they combine with the Medicare card and it will help cover some or most of their out of pocket costs. While others may sign up for  Medicare Advantage plan.

Kyle Nystrom · Answer

Extended Care/Long Term Care (XTC) is the largest gap in Medicare's coverage. Once you've been discharged from the hospital or skilled nursing facility to head home, but still need further care (such as getting dressed or otherwise caring for yourself without supervision) Medicare offers zero coverage or help. This gap can be addressed by private Long Term Care Insurance.

Another gap in coverage are expensive and/or injectable specialized medications as they are minimally covered by Part B and/or Part D. Critical Illness/Benefit policies can be used to address this gap. This is also an area of focus for Medicare with ongoing price negotiations with drug manufacturers.

Jason Meadows · Answer

Great question — and it’s something a lot of people don’t realize at first 👍

Original Medicare (Parts A and B) covers many healthcare services, but it does not pay for everything. Some common gaps include deductibles, coinsurance (like the 20% you pay under Part B), and no cap on out-of-pocket costs, which can add up over time. It also generally does not cover things like dental, vision, hearing, or most long-term care, which is why many people look into additional coverage to help fill those gaps.

Steven Guiness, CSA · Answer

Four main gaps,,, the big one,,,,,,, NO MAXIMUM OUT OF POCKET LIMIT. On original Medicare, parts A and B.

The Big three, Lifestyle, no DENTAL, no routine VISION, no routine Hearing exams or hearing aids.

Part A and B do not cover most self-administered prescription drugs...   Steve Guiness,CSA

Richard Allen · Answer

Medicare typically covers 80 percent of the Medical expenses leaving you or your plan with the remaining 20 percent.  You can choose a Hospital Indemnity plan to help with the gaps for inpatient hospital visits.

Maria Pantall · Answer

Medicare Parts A and B don't cover everything, they have some gaps like deductibles, copays and coinsurances (20%) majority medical services. They also don't include routine dental, vision and hearing.

Beth Duncan · Answer

Some of your out-of-pocket expenses would be Monthly Premiums, Annual Deductibles, Co-insurance, Co-pays, and many other costs. I am happy to discuss these, and ways to help cover these Gaps and expenses.

Gail Patel · Answer

Original Medicare (A&B) will only pay 80% and you are responsible for the other 20%. Gaps like hospital admission, daily cost of care, deductibles and whatever the doctor might bill you. There is different types of coverages to fill in those gaps and I go through each one of them to make sure you understand your out of pocket expense and potential savings.