Original Medicare, Parts A and B together, covers a great deal. What surprises people is the list of everyday things it doesn’t. Here’s that list, and what usually fills each gap.
Prescriptions you pick up at a pharmacy
Part B covers some drugs administered in a clinical setting, but the medicines you collect yourself generally aren’t covered. That’s what Part D is for, either as a standalone plan or built into a Medicare Advantage plan.
Worth knowing: going without prescription coverage when you’re first eligible can add a permanent penalty to your premium later. It isn’t a one-time fee; you keep paying it. If you take no medications today, that’s exactly the situation the penalty catches out.
Routine dental, vision and hearing care
Cleanings, glasses, hearing aids and the exams that go with them aren’t covered by Original Medicare. Some Medicare Advantage plans include benefits for them, and standalone dental and vision plans can be bought separately at more or less any time of year.
Long-term custodial care
Help with daily living (bathing, dressing, eating) isn’t covered when that’s the only care needed. Medicare does cover skilled nursing care after a qualifying hospital stay, which is a narrower thing than most people assume it to be.
Care outside the United States
Coverage abroad is very limited. Some Medicare Supplement plans include a foreign travel emergency benefit, up to the plan’s limits, which is worth knowing about if you travel.
Your share of the bill, without a ceiling
This is the gap people underestimate. Original Medicare pays most of a covered bill and leaves you deductibles, copayments and coinsurance, and on its own, there is no annual limit on how much that adds up to.
The two ways of dealing with that are the whole Supplement-versus-Advantage decision. A Supplement pays that share for you. An Advantage plan puts a yearly cap on it. They work differently and you choose one.
The short version
Nothing on this list is a flaw in Medicare. They’re just the edges of what it does, and each has a well-worn way of being handled. Knowing where they are before you need to is the entire point of having this conversation early.