Medicare Tips: Do you know the 3 gaps in Medicare?


“What are the three gaps in Medicare coverage, and how can you fill them?

Original Medicare – Parts A & B – is a fantastic program, but it has three gaps that every person should be aware of:

1. Unlimited out-of-pocket costs – Original Medicare does not have a cap or limit on your cost-sharing for Medicare approved services.
2. Prescription Drug Coverage – Original Medicare does not cover the cost of most prescription drugs. A separate program – Medicare Part D covers drugs. You need to enroll in Part D separately to get that coverage.
3. Doctors – Medicare does not have a clearly defined network of health care providers or a list of doctors who are required to accept Medicare patients.

So, when you’re enrolling in Medicare be aware of these gaps and the private insurance programs available to fill them.

To fill all three gaps, a person can either:

Enroll in a:
1. Medicare Advantage Prescription Drug plan – these plans are legally required to have a cap on your out-of-pocket medical costs; they must provide Part D prescription drug coverage; and they must have a clearly defined network of doctors who accept the plan.

Your other option is to enroll in a Medicare Supplement plan and a separate prescription drug plan.
2. Medicare Supplements are designed to cover your out-of-pocket medical costs.
3. Medicare Part D Prescription Drug plans –provide prescription drug coverage through Medicare Part D.”

Medicare has neither reviewed nor endorsed this information.
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