Medicare Coverage Gaps

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), but it does not cover long-term custodial care, such as help with daily living tasks in a nursing home or at home. It also has no cap on out-of-pocket costs for Part B services, and beneficiaries pay 20% of the Medicare-approved amount for most doctor visits and outpatient care.

Medicare Advantage (Part C) plans bundle Parts A and B and often include extra benefits, but coverage varies by plan and location. These plans may have network restrictions and require referrals for specialists, and they typically do not cover long-term care either. Enrollees must still pay monthly premiums and may face balance billing in certain situations.

Many people add Medigap (Medicare Supplement) insurance to cover gaps like deductibles, copayments, and coinsurance. Medigap policies do not include prescription drugs or long-term care, and they only work with Original Medicare. People under 65 may have limited options or higher costs depending on state rules and underwriting standards.