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.

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

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, NE & WY

Answered by Mark Cunningham 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.

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 call me directly at 239-848-8893.

Answered by Paul Dzierzanowski on April 11, 2025

Agent Licensed in FL

Answered by Paul Dzierzanowski Medicare Insurance Agent

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

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.

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 
My work phone number is 737-530-4626 pick option 2. I cover every state except New York and Massachusetts 
My name is Gary Henderson

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

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?

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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?

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