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If you are 65 or older; under 65 with certain disabilities; or any age with End-Stage Renal Disease, you qualify for Medicare. Parts A and B make up the basic Original Medicare coverage a beneficiary has.

  • Part A (Hospital Insurance) helps cover inpatient care in hospitals as well as skilled nursing facilities, hospice, and home health care.
  • Part B (Medical Insurance/Outpatient) helps cover doctors’ and other health care providers’ services, hospital outpatient care, durable medical equipment, and home health care as well as preventive services to help maintain your health and to keep certain illnesses from getting worse.

Coverage with these two parts ALONE

Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have additional insurance.

Parts A and B have DEDUCTIBLES, COPAYS, COINSURANCES, and other out of pocket expenses.

Here are some of the most notable or largest gaps in your Original Medicare coverage:

Dental, Vision and Hearing

One of the most asked about gaps in Medicare is Dental, Vision and Hearing. Medicare does not cover the typical Dental, Vision or Hearing (DVH) out of pocket costs. Also, Medicare Supplements or Medigap plans don’t cover these.

Occasionally a Medicare Advantage plan has slight benefits for these, but most of the time they are still inadequate.

There are several stand-alone Dental, Vision and Hearing Plans that can fill in the blanks for your Medicare here, but only one of the plans covers all three while simultaneously allowing you to use any Dentist, Optometrist or Audiologist.

You can check the plan out here:

Dental, Vision and Hearing Plan Details

Prescription Drugs

Another key gap is Medicare Part D or prescription drug coverage.

With an average of 20 Part D plans available in every zip code, its one of the most complex to decide on, but it is vital in the long run to ensure you have this coverage.

Here is a video on how to pick a Part D plan on your on, but if you’d like our agents can help you pick one as well.

Researching Your Own Part D Plan

Medicare Supplements

A Medicare Supplement is an optional plan that helps pay for out of pocket expenses associated with Parts A and B.

Part A has a Deductible for hospital admission, Part B has a deductible for outpatient expenses, Part A has a daily copay after awhile that is a deal breaker, Part B has a 20% coinsurance, Medicare itself has potential 15% excess charges, and there are many other holes in Medicare, but Medicare Supplements or Medigap Plans can fill all or most of these holes.

Medicare Supplement policies are standardized and regulated by the federal and some state governments, so searching for one is simple. When you shop for Medicare Supplement coverage, remember that the benefits for each policy are the same regardless of which company you select. The only difference will be the prices you pay for each policy as well as how a company determines rate increases.

The most popular plans are Medicare Supplements Plan F, G and N. We recommend Plan F or G because they both cover excess charges.

Here is a video I did explaining Medicare Supplement F and G differences:

Medicare Supplement Plan F vs Plan G

Medigap Plan F, G or N

So, when deciding if Original Medicare is enough for you, just determine what amount of out of pocket costs you are okay with. Clearly, the unlimited 20% coinsurance on Medicare is a deal breaker, but you may be open to some out of pocket. If you need help choosing, we can certainly help.

You can call us at 1-800-462-3980 or submit a quote request by going here:

Request Quote or Information

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Justin Brock

President & CEO of Bobby Brock Insurance