Original Medicare (Parts A and B) provides valuable health insurance for millions of Americans. However, many people are surprised to learn that it doesn't pay for everything.

Understanding these coverage gaps can help you prepare for unexpected healthcare expenses and decide whether additional coverage may be right for you.

1. Hospital Deductibles and Coinsurance

Although Medicare Part A helps cover inpatient hospital care, you may still be responsible for deductibles and daily coinsurance costs during longer hospital stays.

These expenses can add up quickly, especially if you require extended hospitalization or skilled nursing care.

2. 20% Part B Coinsurance

After Medicare pays its share for covered outpatient services, you generally pay 20% of the Medicare-approved amount for many doctor visits, outpatient procedures, durable medical equipment, and other Part B services.

Unlike many insurance plans, Original Medicare does not place an annual limit on these out-of-pocket costs.

3. Dental, Vision & Hearing Care

Routine services such as:

• Dental cleanings

• Eye exams for glasses

• Hearing exams

• Hearing aids

are generally not covered by Original Medicare.

Many beneficiaries choose separate dental, vision, or hearing insurance to help with these expenses.

4. Prescription Drugs

Original Medicare generally does not include most outpatient prescription medications.

Many beneficiaries enroll in a separate Medicare Part D prescription drug plan or have other creditable drug coverage.

*5. Long-Term Care

One of the biggest misconceptions is that Medicare pays for long-term custodial care.

In reality, Original Medicare generally does not cover ongoing assistance with daily activities such as:

• Bathing

• Dressing

• Eating

• Personal care

Long-term care planning often requires separate financial planning or insurance solutions.

Why These Gaps Matter

Healthcare costs can change over time, and even routine medical needs may create unexpected expenses.

Understanding what Original Medicare does, and does not, cover allows you to make informed decisions about your healthcare coverage.

Many people choose Medicare Supplement and ancillary insurance products to help address some of these gaps based on their individual needs and budget.

Ready to Explore Your Options?

Every person's healthcare needs are different.

If you'd like to better understand your Medicare coverage options, I'm here to help you compare plans and answer your questions.

*Disclosure: While long-term care is an important part of retirement planning, CACHIS does not sell or advise on long-term care insurance products.