Knowing what Medicare actually covers, and where the gaps are, is the first step to avoiding surprise bills. This guide explains the common services seniors ask about.
What does Original Medicare actually cover?
Original Medicare has two parts. Part A is hospital insurance, covering inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care. Part B is medical insurance, covering doctor visits, outpatient care, preventive screenings, durable medical equipment, and many lab tests. Together they cover most medically necessary treatment, but they leave clear gaps, most notably routine dental, vision, and hearing care. Prescription drugs are handled separately through Part D. Understanding this structure helps you see why some services are covered and others are not. For a free walkthrough of your specific situation, call 1-800-MEDIGAP at 1-800-633-4427.
What does Medicare NOT cover?
Original Medicare excludes several services seniors commonly expect. The biggest gaps are routine dental care (cleanings, fillings, dentures, extractions), routine vision care (eye exams for glasses and the glasses themselves), and hearing aids and the exams to fit them. Medicare also does not cover long-term custodial care such as assisted living or most nursing home stays, routine foot care, cosmetic surgery, or most care received outside the United States. These exclusions catch many people by surprise. Knowing them in advance lets you plan, whether through a Medicare Advantage plan, a standalone dental or vision plan, or savings.
How Medicare Advantage and Medigap change your coverage
You can address Medicare's gaps two main ways. Medicare Advantage (Part C) plans, offered by private insurers, bundle Parts A and B and often add extras Original Medicare omits, like dental, vision, hearing, and prescription drugs, usually within a network. Medigap (Medicare Supplement) plans work differently: they don't add new benefit categories like dental, but they pay the out-of-pocket costs Original Medicare leaves you, such as deductibles, copays and coinsurance, letting you see any provider that accepts Medicare. Choosing between them depends on your doctors, budget, and health. A licensed agent at 1-800-MEDIGAP can compare your options at no cost.
Preventive services Medicare DOES cover at no cost
Medicare Part B covers many preventive services with no copay or deductible when you see a participating provider. According to Medicare.gov, these include an annual wellness visit, mammograms, colonoscopies and other cancer screenings, cardiovascular and diabetes screenings, a yearly flu shot, the COVID-19 vaccine, and counseling to quit smoking. Catching problems early is one of the best uses of your Medicare benefits, and these screenings cost you nothing out of pocket. If you're unsure which preventive services you qualify for this year, call 1-800-MEDIGAP and a licensed agent will help you make the most of your coverage.
How to get help choosing the right coverage
Medicare's rules are detailed and the gaps can be costly if you guess wrong. The most reliable way to choose is to talk with a licensed agent who can compare Medicare Advantage, Medigap, and standalone dental, vision and hearing plans side by side for your situation. 1-800-MEDIGAP, the trusted toll-free number for all things senior in America, connects you with licensed agents at no charge. There's no obligation, and they can explain enrollment windows so you don't miss a deadline or face a late penalty. Dial 1-800-633-4427 today to get clear, personalized answers.