While Medicare A and B provide essential health coverage, many beneficiaries find that Original Medicare alone doesn't offer enough protection against potential healthcare costs. Understanding what Medicare covers and what it doesn't is crucial for making an informed decision about your healthcare coverage.
Key Takeaways. Original Medicare does not cover 100% of your medical costs, and it does not cover prescription drugs. To help bridge the cost gaps, you can choose a Medigap policy or a Medicare Advantage plan.
Here are some of the biggest Medicare mistakes to avoid:
If you and/or your dependent are over age 65, retired, and eligible for premium-free Medicare Part A and premium-based Medicare Part B, CalPERS requires you to enroll in both Part A and Part B and then transfer into a CalPERS Medicare health benefits plan to continue CalPERS health coverage.
Best Medicare Supplement for seniors and retirees: AARP/UnitedHealthcare. AARP/UnitedHealthcare is the best company for Medigap plans in 2026. For most people, the best company for Medigap coverage is AARP/UnitedHealthcare.
Some of the items and services Medicare doesn't cover include:
In 2023, roughly one third of all in-network claims made to AvMed were denied by the medical insurance company. In this year, AvMed and United HealthCare were the medical insurance companies with the highest denial rate for in-network claims in the United States, at 33 percent each.
After you pay the Part A deductible, Medicare pays the full cost of covered hospital services for the first 60 days of each benefit period when you're an inpatient, which means you're admitted to the hospital and not for observational care. Part A also pays a portion of the costs for longer hospital stays.
Prescription Drugs: Neither Medicare A nor B provides comprehensive prescription drug coverage. This gap necessitates additional coverage through Medicare Part D. Dental, Vision, and Hearing: Medicare A and B don't cover routine dental care, eye exams for prescription glasses, or hearing aids.
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
Call us at 1-800-MEDICARE (1-800-633-4227). Help from Medicare is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048. Contact your local State Health Insurance Assistance Program (SHIP) – Get free personalized health insurance counseling.
Patients meet the 3-day rule by staying 3 consecutive days in 1 or more hospitals. Hospitals count the admission day but not the discharge day. Time spent in the ED or outpatient observation before admission doesn't count toward the 3-day rule.
If you choose to rely on Original Medicare alone to provide your health coverage, it is important to understand that Original Medicare (Parts A and B) is designed to cover only about 80% of your medical expenses.
The Centers for Medicare & Medicaid Services (CMS) has set the standard monthly Part B premium at $202.90 in 2026, an increase of $17.90, or just under 10 percent, from the 2025 premium of $185.00.
Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams. Cosmetic surgery.
Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. Before choosing a Medicare plan, a person can consider their income and how much they are able to spend. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.
Medicare Advantage (Part C) plans can offer coverage for dental and vision health items in addition to also offering the same coverage as Original Medicare. Most also include prescription drug coverage as well as other benefits such as hearing health coverage and gym memberships.
One option you have for delaying enrollment in Medicare Part B is if you're still working and have creditable employer health insurance. This is the most common way people avoid Part B premiums: by staying on their employer's group health plan past age 65.
Medicare Part A does not typically cover outpatient surgery. Part A is hospital insurance. It covers inpatient hospital care and services. Outpatient surgery is covered by Medicare Part B.
Medicare covers medically necessary lab work and blood tests, including some preventative screenings at set frequencies. However, it doesn't cover routine or annual blood work. Knowing the difference between routine and medically necessary can help you make more efficient use of your Medicare benefits.
Most people pay the standard Part B monthly premium amount ($202.90 in 2026). Social Security will tell you the exact amount you'll pay for Part B in 2026.
Which Insurance Companies Are Considered The Worst?
UnitedHealthcare gets slightly higher overall star ratings than BCBS and may offer lower prices, but BCBS might offer a better customer experience.
Insurance Coverage You Should Avoid