Understanding the various capabilities and limitations of Medicare is essential for anyone approaching eligibility or currently enrolled. While Medicare can provide valuable and cost-effective health coverage, it comes in several forms. As a policyholder, you should make sure you’re aware of what plans might not cover and how you can address these gaps.
What Original Medicare May Leave Out
Original Medicare (Parts A and B) can cover many hospital and medical services, but it doesn’t pay for everything you might need. Some of the most common coverage gaps and costs for those with only Parts A and B may include the following: 
- Deductibles—These clauses in health insurance policies establish minimum out-of-pocket amounts you’re responsible for contributing in a single plan year.
- Copays and coinsurance—These represent flat fees and percentages, respectively, that you contribute toward specific services and procedures.
- Prescription drug costs—Most outpatient prescription medications are not covered under Original Medicare.
- Dental, vision and hearing care—Services like dental cleanings, eyeglasses and hearing aids are generally excluded from Original Medicare.
How Medicare Supplement Plans Can Help
Medicare Supplement plans, also known as Medigap, are designed to help pay for many of the costs that Original Medicare doesn’t cover. Specifically, they may assist in the following ways:
- Reducing out-of-pocket costs—Medigap plans can cover deductibles, coinsurance and copays, reducing your financial burden.
- Increasing cost predictability—With a supplement plan, you may have more predictable health care costs, making it easier to budget.
- Providing greater flexibility—Medigap plans can typically work with many providers that accept Medicare, helping you keep your preferred doctors and hospitals.
Additional Coverage Options
In addition to a Medigap plan, you may also benefit from exploring additional Medicare options. Consider the following:
- Prescription drug coverage—Also known as Part D, this can be paired with Original Medicare to help pay for medications you may need.
- Medicare Advantage plans—Also known as Part C, these are purchased through approved private insurers and can bundle Original Medicare and prescription drug coverage, while also potentially covering additional services, such as dental and vision.
We’re Here to Help
At Wimmer Insurance Services, LLC, we help our clients compare plans, understand state-specific benefits, and choose coverage that fits their needs and budget. Contact our team today to get personalized guidance.
This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.