What is missing from Original Medicare?

October 27, 2020
What is missing from Original Medicare?

Medicare is health insurance for people age 65 and older. (There is another group of people who can get Medicare, but let’s leave that aside for now.) Original Medicare, also known as Traditional Medicare or Medicare Parts A and B, is Medicare from the federal government and it’s the simplest, most basic form of Medicare. Medicare Part A covers hospital stays. Medicare Part B covers outpatient medical services.

It’s important to understand that Original Medicare does leave some pretty significant gaps in your healthcare coverage. Original Medicare (Parts A and B) covers 80 percent of eligible doctor and hospital visits, leaving you to pay the remaining 20 percent. That means one hospital stay could cost you thousands of dollars — and there is no limit to the amount you would have to pay.

What else is missing from Original Medicare? Let’s break it down further.

Prescription drug coverage

Original Medicare does not cover prescription drug medications. This means that you have to pay for them or enroll separately in a Medicare Part D prescription drug plan. Or, you can enroll in a Medicare Advantage Plan with Part D coverage (MAPD).


Original Medicare has no out-of-pocket limit. This means that there’s no limit on the amount you may have to spend. All Medicare Advantage plans have limits on your out-of-pocket costs. These amounts vary by plan.

Dental benefits

Original Medicare does not cover most dental care, including cleanings, fillings, tooth extractions, dentures, dental plates, etc. It only pays for emergency or complicated dental procedures. Generally, Medicare Advantage is the only way to get dental services covered under Medicare. Coverage options vary by plan and can include both preventive and comprehensive dental coverage. Some plans offer this as an enhanced benefit and others include it in their core product.

Vision benefits

Original Medicare does not cover eye exams related to prescribing glasses. In addition to Medicare-covered diagnostic vision exams, some Medicare Advantage plans will include vision enhancements including a yearly routine exam and eyewear allowance.

Hearing aids

Original Medicare does not cover routine hearing exams or hearing aids. In addition to Medicare-covered diagnostic hearing exams, a Medicare Advantage plan will usually include hearing enhancements including a yearly routine exam and hearing aid allowance.

Additional supplemental benefits

A Medicare Advantage plan will cover everything Original Medicare does and more, sometimes including extra benefits that can save you money and help you stay healthy. These include transportation to appointments, meal deliveries, routine chiropractic services, routine acupuncture and fitness benefits.

If you have any additional questions on what Original Medicare covers (or doesn’t cover) you can use the online coverage tool. Aspire Health Plan offers Monterey County’s only Medicare Advantage plan. Visit our plans & rates page to use our comparison tool and get specific benefits highlights or call (877) 286-4965, TTY users call 711, to speak with a Health Plan Advisor.

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  • June 18, 2022 at 5:53 am, Anna Collins says:

    My dad is turning 65 soon, and since we have hospital bills to pay, I was thinking of enrolling him in Medicare. I appreciate you letting us know that original Medicare doesn’t have a limit on the amount you have to spend, but Medicare Advantage plans do and they vary by plan. I’ll be sure to remember this once I find a trusted agency for Medicare health plan options. https://ellendanielsagency.com/medicare-health-plan

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