Is Original Medicare Parts A & B Enough Coverage?

Original Medicare — made up of Part A and Part B — provides essential healthcare coverage for eligible individuals aged 65 or older, younger individuals with qualifying disabilities, and those with End-Stage Renal Disease (ESRD).

While Parts A and B offer important protections, they do not cover all medical costs.

Understanding where coverage stops — and how to fill in the gaps — is crucial to protecting your health and finances.

What Original Medicare Covers

Part A (Hospital Insurance) and Part B (Medical Insurance) are the foundation of Original Medicare:

• Part A helps cover inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services.

• Part B helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and home health care.

Together, these two parts offer significant coverage — but they still leave important gaps that can expose you to out-of-pocket costs like deductibles, copayments, and coinsurance.

Gaps in Original Medicare Coverage

Even with Parts A and B, Medicare does not cover everything. Beneficiaries are responsible for various costs and certain services not included under Original Medicare.

Dental, Vision, and Hearing Care

One of the most common gaps in Original Medicare is the lack of coverage for dental, vision, and hearing (DVH) services.

Neither Medicare Parts A or B — nor Medicare Supplement (Medigap) plans — cover routine dental cleanings, eyeglasses, hearing aids, or exams.

Some Medicare Advantage plans offer limited DVH benefits, but coverage is often minimal.

Standalone dental, vision, and hearing insurance plans are available and may be worth considering if you want broader protection.

Prescription Drug Coverage (Part D)

Original Medicare does not include prescription drug coverage.

To get help paying for medications, you need either:

• A standalone Medicare Part D plan, or

• A Medicare Advantage plan that includes drug coverage (MAPD).

Choosing a Part D plan is important even if you are not currently taking medications — enrolling late can result in permanent penalties.

Out-of-Pocket Costs

Medicare Parts A and B come with several types of cost-sharing:

There is no out-of-pocket maximum with Original Medicare.

Without additional coverage, your exposure to medical costs could be unlimited.

Medicare Supplements: Filling the Gaps

Medicare Supplement plans (also called Medigap plans) help pay for the costs that Original Medicare leaves behind, such as deductibles, copayments, and coinsurance.

These plans are standardized by the federal government, meaning the benefits of a Plan G, for example, are identical no matter which insurance company offers it.

Popular Medigap plans include:

• Plan F: Covers all gaps, including the Part B deductible (available only to those eligible for Medicare before 2020).

• Plan G: Covers all gaps except the Part B deductible.

• Plan N: Covers most gaps but has small copays for doctor visits and emergency room trips.

When comparing Medicare Supplement plans, the biggest differences are the premiums charged by insurance companies and how they handle future rate increases.

How to Decide If Original Medicare Is Enough

Deciding whether Original Medicare alone is sufficient depends on your comfort level with potential out-of-pocket costs.

• If you are concerned about the unlimited 20% coinsurance and hospital expenses, adding a Medicare Supplement plan or a Medicare Advantage plan could offer significant financial protection.

• If you prefer lower premiums and are willing to accept more personal financial risk, Original Medicare may meet your needs — but you should budget carefully for unexpected healthcare costs.

Planning ahead helps ensure you aren’t caught off guard by gaps in coverage.