Traditional Medicare

Coverage Gaps in Traditional Medicare

Medicare Part A provides hospital coverage. It will help pay for “room and board” fees for any inpatient hospital stays. Part A will begin paying for expenses after the deductible for the benefit period has been met. ($1,632)

Most individuals receive premium-free Part A. As long as an individual has worked for ten years and paid payroll tax during that time, Part A will remain premium-free. 

Gaps in Part A 

Days 1–60: $1,632 deductible-100% covered for the rest of the quarter in the hospital

Same hospital stay: Days 61–90: $408 coinsurance PER DAY

Days 91 and beyond: $800 coinsurance PER DAY 

Each day after lifetime reserve days : ALL COSTS

Part B offers benefits for outpatient medical care. This includes visits to the doctor and many preventive services. It will pay 80% of covered services after the annual deductible has been met ($240 in 2024) The standard Part B Premium for 2024 is $174.70 

Gaps in Part B

$240 Annual Part B Deductible Met - 80/20 split after, uncapped. This means unlimited financial exposure. You pay the 20% cost share regardless of how big the bill is. 

Part B Excess Charges: Medical Providers reserve the right to charge an additional 15% of the Medicare approved rate. Ex: $10,000 bill = $1,500 in Excess Charge

Part C plans offer “all-in-one” Medicare coverage. They bundle the benefits from Parts A and B and sometimes include additional benefits for routine dental, vision, and hearing services, as well as prescription drug coverage. Medicare Advantage Plans are managed and issued by private insurance carriers contracted with Medicare.

If an individual enrolls in a Part C plan, the benefits are all provided by the private insurance company instead of the traditional Medicare program.

Part D offers prescription drug coverage. Like Part C plans, Part D plans are offered by private insurance companies.

Most Advantage plans have Part D Drug Coverage built into the plan (MAPD)

With a Medicare Supplement you must add a stand alone Part D Drug Plan (PDP)