Important facts about Medicare Part A and Part B coverage gaps

Health care needs are different for each person and within each family. Also, health care needs change over time – especially as we age. That’s why it’s important to understand the differences within the Original Medicare plans and know that there are coverage options that will address your needs as they change.

It’s possible that your current Medicare plan doesn’t meet all your needs. Or maybe you’re considering Medicare coverage and noticing you’ll need additional coverage for dental, routine vision, hearing, or prescription medicine. That’s OK — some plans offer coverage for these, and they just might be right for you.

There are five coverage gaps you should be aware of within Medicare Part A and Part B. Understanding where these gaps are can help you can make an informed decision. We’re here to help make sense of the plans so you can choose the right one for all your needs.

Understand these five gaps:

  1. Prescription drug coverage — Medicare Part A and Part B cover medicine you get while in the hospital as an inpatient. Part B may cover some outpatient medicine you would get at a doctor’s office, such as intravenous or chemotherapy medication. But with the Original Medicare plans, you’ll likely need to pay for all other prescription drugs. You can avoid this by enrolling in a Medicare Part D Plan. This is a stand-alone drug plan that can help with out-of-pocket medication costs.
  2. Routine vision care — If you need routine eye exams, glasses, or contact lenses, you may consider enrolling in a Medicare Advantage plan. These plans are an alternative way to get your Original Medicare plan coverage (Part A and Part B) and additional benefits.
  3. Routine dental care — If you need coverage for dental care, including oral exams, cleanings, dentures, and fillings, you’ll want to consider additional coverage.
  4. Routine hearing care — If you need coverage for hearing aids, exams for fitting hearing aids, or hearing exams, Medicare doesn’t cover those medical expenses. However, Medicare Part B covers diagnostic hearing and balance exams if your doctor orders them to determine if you need medical treatment. You’ll incur a little cost, approximately 20% of the Medicare-approved amount and the Part B deductible.
  5. Nursing home care — If you need long-term care, Medicare generally doesn’t cover this. You most likely will pay out of pocket for this care. You may be eligible for Medicaid — coverage for those with limited income and resources. Or you might consider long-term care insurance. You’ll want to find out what types of long-term care services and facilities different policies cover.
  6. Health care coverage while traveling outside the U.S. — If you travel outside the U.S., you’ll want to consider Medicare supplement insurance, called Medigap. There may be some exceptions to Medicare coverage outside the U.S., but they are rare.

Don’t Forget to Enroll

By understanding these key gaps, you can make a more informed decision about which Medicare plan is right for you. Once you do decide, don’t forget to enroll. You could pay a late enrollment penalty if you miss the deadline.

  • The Initial Medicare Enrollment Period starts three months before turning 65 and ends three months after you turn 65.
  • The General Medicare Enrollment Period (if you miss the Initial Enrollment Period) for Part A and B is from January 1 to March 31. Coverage starts July 1.
  • You can sign up for a Medicare Advantage plan or prescription drug plan when you first sign up for Medicare. If you miss that chance, the Open Enrollment Period for Medicare Advantage and prescription drug plans is October 15 to December 7. You can also drop or change your coverage during this period.
  • You can enroll during a Special Enrollment Period if you meet specific requirements.

Next Steps

If you’re interested in learning whether Medicare is right for you, we’re right here, ready to help. Are you ready to talk to one of our specialists about Medicare plans? Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.

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As you prepare for Medicare, you’ll be faced with many important decisions. LEON Health wants to help you select the best options for your needs.

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