Does Medicare Cover Everything? What It Leaves Out and How to Fill the Gaps

One of the most common surprises for people turning 65 is that Medicare doesn't cover everything. It covers a lot, but there are gaps, and some of them are expensive. Here's what Original Medicare leaves out and the practical ways my clients in Ocean and Monmouth County fill them.

What Original Medicare doesn't cover

• Your 20% share of Part B costs, with no annual cap.

• Routine dental: cleanings, fillings, crowns, dentures, implants.

• Routine vision: eye exams for glasses, and the glasses themselves.

• Hearing aids and the exams to fit them.

• Long-term custodial care in a nursing home or at home.

• Care outside the United States, with narrow exceptions.

• Prescription drugs, unless you add a Part D plan.

How people close the gaps

• Medigap (Medicare Supplement): picks up most or all of the 20% and the deductibles. Predictable costs, any doctor that takes Medicare.

• Medicare Advantage: caps your out-of-pocket costs and usually adds dental, vision, and hearing benefits.

• Standalone dental plans: for people on Original Medicare plus Medigap who want real dental coverage.

• Hospital indemnity: pays you cash per day in the hospital to offset Advantage plan copays.

• Cancer, heart attack and stroke plans: a lump sum at diagnosis for the costs no plan covers, like travel, time off work for a spouse, and household help.

The right combination depends on you

There's no single package that fits everyone. Someone with a lot of doctor visits and a tight budget needs a different setup than someone who's healthy, travels, and wants zero surprises. The mistake I see most often is choosing a plan based on the premium and finding out about the gaps the hard way.

If you'd like a clear picture of what your coverage does and doesn't do, call (732) 554-3021 or book a free consultation. I'll walk through it with you in plain English.