5 Important points about Medicare Part A and B coverage gaps

Two male senior citizens share a laugh as their walk down a path.

Original Medicare, which consists of Parts A (hospital insurance) and B (medical insurance), provides many coverage options. It does not cover everything though, and other coverage may be needed to fill in the gaps.

To help you better understand Original Medicare, here are five things that Parts A and B do not cover:

1. Prescription drugs

Medicare Parts A and B do not cover the cost of prescription drugs. You will need to obtain a Medicare Part D prescription drug plan via one of the independent insurance companies offering them.

You can also consider a Medicare Advantage plan which typically includes prescription drug coverage among the many other costs covered, or some other type of Medicare supplemental insurance plan.

2. Dental costs

Many Medicare Advantage plans and other supplemental plans provide help with dental care. Under certain situations, Medicare Part A does cover dental procedures. These include some dental services while hospitalized, and certain emergency procedures.1 Routine dental care is not covered, however.

3. Vision care

Routine vision care is not covered by Original Medicare. This includes such services as eye exams or the cost of eyeglasses. There are some exceptions.

Part B benefits will cover annual glaucoma screenings for those deemed to be at high risk for this condition.2 Part B also helps cover cataract surgery and related costs including vision correction products.3

4. Long-term hospital stays

Medicare Part A does cover the costs of hospital care, but there are limits. For days 61–90 there is a $329 coinsurance amount for 2017. For day 91 and beyond there is a $658 coinsurance amount for each lifetime reserve day you have left. Each person has a total of 60 lifetime reserve days.4

5. Maximum out-of-pocket costs

Both Parts A and B have varying maximums and minimums for out-of-pocket costs. Sometimes there is no out-of-pocket maximum. For example, if you have an extended hospital stay, you are responsible for all costs if you exceed your maximum lifetime reserve days.5

The role of a Medicare Advantage plan

A Medicare Advantage plan will cover the costs listed above and many other costs and services not covered by traditional Medicare Parts A and B. Medicare Advantage plans are offered by private insurance companies and most include prescription drug coverage.6

Medicare Advantage plans come in a number of forms including health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service plans, special needs plans, and Medicare medical savings account plans. The Medicare Advantage plan will pay for covered services which would normally be paid via Parts A and B.

It's important to remember that not all Medicare Advantage plans work the same way, and their costs and coverages are different.

When deciding which plan is best for you, you should research and compare plans not only during your Initial Enrollment Period, but also during the Medicare Annual Open Enrollment from October 15 to December 7 each year. Plans and coverages can change, as can your situation and your needs.7

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