5 important points about Medicare Parts A and B coverage gaps

Original Medicare offers Part A (hospital insurance) and Part B (medical insurance)—coverage that covers many of your healthcare needs once you enroll. But it doesn’t cover everything.

To help you fill in the gaps, consider these 5 important cost factors.

1. Prescription drugs

Original Medicare doesn’t include prescription drug coverage (though some drugs are covered under Part B). And prescription drugs can be a budget buster. If you want coverage, you have options:

  • You can purchase a stand-alone prescription drug plan to add to Original Medicare
  • You can choose a Medicare Advantage plan that includes coverage for prescription drugs

2. Dental costs

  • Original Medicare does not cover routine dental care, although some dental services while hospitalized and certain emergency procedures are covered
  • Many Medicare Advantage plans include dental care in their coverage, including preventive care all the way up to root canals and dentures

3. Vision care

  • Routine vision care is not covered by Original Medicare. So if you wear glasses or contacts, you’ll have to pay out of pocket for most exams and eyewear.
  • Part B benefits will cover annual glaucoma screenings for those deemed to be at high risk for this condition. Part B also helps cover cataract surgery and related costs including vision correction products.
  • Many Medicare Advantage plans include coverage for routine eye exams, eyeglasses (frames and lenses) and contact lenses

4. Long-term hospital stays

Medicare Part A covers some of the costs of hospital care but not all. For an extended hospital day, be aware of the following limits for 2019:1

  • You’ll need to pay a $1,364 deductible for each “benefit period”*
  • Days 1–60, you’ll pay $0 coinsurance for each benefit period
  • Days 61–90, you’ll pay $341 coinsurance per day of each benefit period
  • Days 91 and beyond, you’ll be responsible for paying $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)**
  • If you run out of lifetime reserve days, you’ll pay 100% of your costs

*A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you haven't gotten any inpatient hospital care (or skilled care in an SNF) for 60 days in a row. If you go into a hospital or am SNF after 1 benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

** Original Medicare covers up to 90 days of inpatient hospital care each benefit period. You also have an additional 60 days of coverage, called lifetime reserve days. These 60 days can be used only once, and you will pay coinsurance for each one ($682 per day in 2019).

5. Maximum out-of-pocket costs

All Medicare Advantage plans must include a guaranteed annual maximum out-of-pocket cost for covered services.

Medicare Advantage is growing

Medicare Advantage plans are required by law to provide—at minimum—all the benefits of Original Medicare Part A and Part B. Most also provide coverage for dental, vision and hearing care, as well as prescription drug coverage.

That’s how they compete for your business. And the trend is clear: In 2018, 33% of Medicare members chose a Medicare Advantage plan, and that percentage is expected to grow to about 42% over the next decade.2

Bottom line? Know your options. Whether you opt for Original Medicare or a Medicare Advantage plan, a little homework can help you choose with confidence.

Sources

  1. “Medicare Costs at a Glance,” Medicare.gov, last accessed May 10, 2019, medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4811, opens new window.
  2. “A Dozen Facts about Medicare Advantage,” Gretchen Jacobson, Anthony Damico and Tricia Neuman, Henry J Kaiser Family Foundation, last accessed May 10, 2019 kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage, opens new window.

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