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What are gaps in coverage with Medicare?

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Medicare is a federal health insurance plan for people 65 and older, or with certain disabilities. The main Medicare plans are called A, which covers hospital services, and B, which pays for doctor visits, lab tests, and other outpatient services.

  • Original Medicare doesn't cover some essentials. For instance, it does not pay for most prescription drug costs.
  • Even when Medicare covers a treatment, you still have to pay copays (a fixed amount you pay for some services) and coinsurance (a percentage share of the medical bills not covered by Medicare).
  • Most people have to pay a monthly fee, called a premium, for Medicare Part B.

SOURCES:

Centers for Medicare and Medicaid Services: "What Medicare Covers," "What's not covered by Part A & Part B?" "Supplements & other insurance," "What's Medicare supplement (Medigap) insurance?" "Your Medicare Coverage: Hospital Care," "Medicare Coverage of Durable Medical Equipment and Other Devices," "Decide how to get your Medicare," "Medicare Advantage Plans," "Catastrophic coverage," "How do Medicare Advantage Plans work?" "Medicare & You," "How to Get Drug Coverage," "Save on Drug Costs," "Medicaid," "Medicare Advantage Plans Cover All Medicare Services," "Medicare Savings Programs,"  "What is Long-term Care?" "Help with Medical and Drug Costs," "Part B Costs," "Prescription drugs (outpatient) limited coverage," "Medicare Prescription Drug Coverage(Part D)."

Social Security Administration: "Income and resource requirements for the Extra Help with prescription drug costs."

Kaiser Family Foundation: "Medigap: Spotlight on Enrollment, Premiums and Recent Trends," "Medicare Advantage."

Families USA: "Stand Up for Health Care: Filling the Financial Gaps in Medicare Coverage."

Marc Steinberg, deputy director of health policy, Families USA.

Medicare Interactive: "Can I Have Both Medicare and Veteran's Benefits?"

AARP: "10 Misconceptions about Long-Term Care Insurance."

NIH Senior Health: "Long-Term Care."

Reviewed by Sarah Goodell on June 01, 2018

SOURCES:

Centers for Medicare and Medicaid Services: "What Medicare Covers," "What's not covered by Part A & Part B?" "Supplements & other insurance," "What's Medicare supplement (Medigap) insurance?" "Your Medicare Coverage: Hospital Care," "Medicare Coverage of Durable Medical Equipment and Other Devices," "Decide how to get your Medicare," "Medicare Advantage Plans," "Catastrophic coverage," "How do Medicare Advantage Plans work?" "Medicare & You," "How to Get Drug Coverage," "Save on Drug Costs," "Medicaid," "Medicare Advantage Plans Cover All Medicare Services," "Medicare Savings Programs,"  "What is Long-term Care?" "Help with Medical and Drug Costs," "Part B Costs," "Prescription drugs (outpatient) limited coverage," "Medicare Prescription Drug Coverage(Part D)."

Social Security Administration: "Income and resource requirements for the Extra Help with prescription drug costs."

Kaiser Family Foundation: "Medigap: Spotlight on Enrollment, Premiums and Recent Trends," "Medicare Advantage."

Families USA: "Stand Up for Health Care: Filling the Financial Gaps in Medicare Coverage."

Marc Steinberg, deputy director of health policy, Families USA.

Medicare Interactive: "Can I Have Both Medicare and Veteran's Benefits?"

AARP: "10 Misconceptions about Long-Term Care Insurance."

NIH Senior Health: "Long-Term Care."

Reviewed by Sarah Goodell on June 01, 2018

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What is Medicare Part D?

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