What gaps does Original Medicare leave me with?

Orientation
Last updated: 
April 10, 2026
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The short answer

Original Medicare covers a lot, but it leaves you responsible for deductibles, coinsurance, and copays with no cap on out-of-pocket costs. It also doesn't cover most dental, vision, hearing, or prescription drugs.

The full explanation

Original Medicare, meaning Part A and Part B, is solid foundational coverage. But it was never designed to cover everything, and the gaps can add up fast.The biggest one is that there is no out-of-pocket maximum. With most private insurance, your costs stop at some point each year. Original Medicare has no such ceiling. A long hospital stay or a serious illness could leave you with tens of thousands of dollars in cost-sharing, which is your share of the bill after Medicare pays its portion.Specifically, Part A has a deductible each benefit period, not just once a year. Part B covers 80 percent of most outpatient services, leaving you responsible for the other 20 percent with no cap. That 20 percent on a major surgery or ongoing specialist care can be significant.Beyond cost-sharing, Original Medicare doesn't cover prescription drugs. You need a separate Part D plan for that. Routine dental cleanings, eyeglasses, and hearing aids are also not covered, which surprises many people.Most people address these gaps by adding either a Medigap plan, sometimes called Medicare Supplement, which helps cover the cost-sharing, or by switching to Medicare Advantage, which bundles coverage and typically adds extra benefits. Each approach has tradeoffs worth understanding before you choose.

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In 

Utah

 specifically

Utah residents can also use the Aging and Disability Resource Center for free Medicare counseling, especially when they need help comparing plans or checking cost assistance programs.

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What this means for you

For you, this means Original Medicare alone likely isn't enough coverage for most people, and choosing how to fill those gaps is one of the most important decisions you'll make at 65.

Related Questions

Still have questions about Medicare?

Book a review with a licensed Medicare advisor.

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