What Does Medicare Not Cover? How to Fill the Gaps in Original Medicare

April 7th, 2025

What Does Medicare Not Cover? How to Fill the Gaps in Original Medicare

When you're turning 65, understanding what Medicare does and doesn’t cover is one of the most important steps in planning your healthcare. Many seniors are surprised to learn that Original Medicare (Parts A and B) has coverage gaps that can lead to significant out-of-pocket costs.

If you're searching for a local Medicare advisor in Gwinnett County or surrounding areas, this guide is for you.

What Does Original Medicare Cover?

Original Medicare includes:

Part A – Hospital Insurance

• Inpatient hospital stays
• Skilled nursing facility care
• Hospice care
• Some home health care

Part B – Medical Insurance

• Doctor visits
• Preventive services
• Outpatient care
• Durable medical equipment

What Medicare Does NOT Cover (The Gaps)

Despite offering essential coverage, Original Medicare doesn’t cover everything. These are some of the most common gaps:

1. Deductibles, Copayments, and Coinsurance

You’re still responsible for paying parts of your bill. These out-of-pocket costs can add up quickly without extra coverage.

2. Prescription Drug Coverage

Medicare Parts A and B do not cover most prescription drugs. You’ll need a separate Part D plan or a Medicare Advantage plan that includes drug coverage.

3. Dental, Vision, and Hearing Care

Routine dental checkups, eyeglasses, and hearing aids are not covered by Original Medicare.

4. Overseas Emergency Care

Original Medicare offers very limited international coverage. If you travel outside the U.S., you’ll need additional protection.

How to Fill the Gaps: Smart Medicare Plan Options

There are two main ways to get more complete Medicare coverage:

✅ Medicare Supplement (Medigap) Plans

• Help pay your Part A and B out-of-pocket costs (like deductibles and coinsurance)
• Let you see any doctor that accepts Medicare nationwide
• Do not include drug coverage, so a separate Part D plan is often needed

✅ Medicare Advantage Plans (Part C)

• Combine Part A, B, and usually Part D in one convenient plan
• Often include extra benefits like dental, vision, hearing, and gym memberships
• Offered by private insurance companies

✅ Medicare Part D – Prescription Drug Plans

• Covers the cost of brand-name and generic medications
• Available as stand-alone plans or bundled in many Advantage plans

Which Option is Right for You?

Choosing the best Medicare coverage depends on your personal needs and lifestyle. Here's a quick comparison:

See any doctor with a Medigap policy that acceps Medicare Nationwide. Lower monthly premiums with Medicare Advantage with many having a $0 premium options. Prescriptions durgs plans also known as Part D is usually included in Medicare Advantage plans. You need to add a standalone Part D if you choose a supplement plan.

Need help choosing the right plan? Our local Medicare experts are here to guide you. Our services are always at ZERO cost to you!

Important Medicare Enrollment Periods

Timing is everything with Medicare. Don’t miss these critical windows:

📅 Initial Enrollment Period (IEP)

• Starts 3 months before you turn 65 and 3 month after your birth month.
• Enroll in Medicare Parts A, B, and optionally Part D or Medicare Advantage

📅 Annual Enrollment Period (AEP)

• October 15 – December 7
• Change or enroll in Medicare Advantage or Part D plans

📅 Special Enrollment Periods (SEP)

• Triggered by life events like moving, retiring, or losing employer coverage

Work with a Local Medicare Advisor in Gwinnett County

At Kim & Co Agency, we help seniors across Gwinnett County and surrounding areas make confident Medicare decisions. Whether you’re new to Medicare or reviewing your current plan, we’ll walk you through every option.

📍 Serving: Buford, Lawrenceville, Suwanee, Duluth, Flowery Branch, Duluth, Sugar Hill, Auburn, Johns Creek, Gainesville, Cumming, & Lilburn.

💬 Call today for your FREE Medicare consultation – and learn how to fill the gaps in your Medicare coverage.

👉 [Schedule your consultation HERE] or call (678-671-1478)

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