Original Medicare Gaps And Fees

Original Medicare, which is made up of Medicare Part A and Part B, covers some, but not all of your medical expenses. It leaves some gaps in coverage, which could leave you paying considerable medical expenses out of pocket without Medicare Supplement Insurance (Medigap).

Keep reading to learn more about the limits of Medicare and how Medigap can help.

What Medicare Doesn’t Cover

Medicare Part A, or hospital insurance, covers inpatient hospital care, hospice care, skilled nursing facility care and some home health services.

Medicare Part B, or medical insurance, covers most medically necessary outpatient care, preventive care, ambulance services and durable medical equipment.

Although Medicare covers a lot, it was not designed to cover all possible Medical expenses. Some services Original Medicare explicitly does not cover, include:

• Most prescription drugs
• Routine dental, vision, hearing or foot care
• Cosmetic surgery
• Acupuncture
• Long-term care
• Custodial (personal) care
• Emergency care outside of the U.S.
• Non-medical services

For a more detailed list of exactly what Medicare will and will not cover, use this guide.

Keep in mind that even if Medicare covers a test, item or service, it likely doesn't cover it 100 percent. Below is a list of some of the common costs associated with Original Medicare.

Costs Under Part A

Most people don’t pay a premium for Medicare Part A (sometimes called “premium-free Part A”) if you’ve worked and paid payroll taxes in the U.S. for 40 quarters. If you do not qualify for premium-free Part A, you can purchase it for up to $505 a month in 2024.

Beyond monthly premiums, Part A also comes with deductibles and copayments for covered services. Your costs under Part A include:

• A $1,632 deductible per benefit period in 2024
• $0 coinsurance for days 0-60 in the hospital
• $408 coinsurance for days 61-90 in the hospital
• $816 coinsurance per day after 90 days in the hospital until you use up your 60 “lifetime reserve days”
• All hospital costs once lifetime reserve days are depleted

Costs Under Part B

Unlike Medicare Part A, you pay a monthly premium for Medicare Part B. The standard premium amount is $174.70 in 2024, although some people may pay more based on income.

Others may pay less due to a Social Security cost of living adjustment. In addition to the premium, Part B includes an annual deductible and coinsurance for most covered services.

Your costs under Part B in 2024 include:

• A $240 deductible each year
• 20% coinsurance for most covered services (once your deductible is met)

Medicare Supplement Insurance

To help cover some of these costs, people with Original Medicare can purchase Medicare Supplement Insurance, also known as Medigap.

Medigap plans are sold by private insurance companies to help cover some of the out-of-pocket costs of Original Medicare. There are 10 standardized plans in most states, labeled A, B, C, D, F, G, K, L, M and N.

Important: Plan F and Plan C are not available to beneficiaries who became eligible for Medicare on or after January 1, 2020.

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