Key Takeaways:

• Original Medicare covers a lot, but it has gaps that could leave you with high out-of-pocket costs if you don’t have additional coverage.

• Some aspects of Original Medicare, like coverage limits and the lack of prescription drug benefits, might not be what you expect.

Original Medicare Isn’t as “Comprehensive” as You Might Think

When you enroll in Medicare, you might assume it covers everything. However, Original Medicare (Parts A and B) has significant gaps. While it provides hospital and medical insurance, it doesn’t cover routine dental, vision, or hearing care. If you need dentures, eyeglasses, or hearing aids, you’ll have to pay out of pocket or get additional coverage.

Another major limitation is the lack of a cap on out-of-pocket costs. Unlike private health insurance, Original Medicare doesn’t have a yearly limit on what you pay for covered services. This means a serious health issue could leave you with high bills, even with Medicare.

Hospital Stays Can Still Be Costly

Medicare Part A covers hospital stays, but that doesn’t mean they’re free. In 2025, you’re responsible for a deductible of $1,676 per benefit period. If you stay in the hospital longer than 60 days, you’ll have to pay daily coinsurance, which increases the longer you stay.

If you require skilled nursing care after a hospital stay, Medicare only covers up to 100 days per benefit period. After the first 20 days, you’re responsible for a daily copayment. And if you need long-term care beyond that, Medicare won’t cover it at all, which is a surprise for many people.

Medicare Doesn’t Cover Prescription Drugs

Unlike most employer health plans, Original Medicare does not include prescription drug coverage. If you rely on medications, you’ll need to enroll in a separate Part D plan or explore other options for prescription drug benefits.

The good news is that Medicare Part D has improved in 2025, with a $2,000 out-of-pocket cap on prescription drug costs. This helps limit how much you spend each year. However, if you only have Original Medicare without Part D, you’ll pay the full cost of prescriptions, which can add up quickly.

Preventive Services Are Covered, But Some Tests and Treatments Aren’t

Medicare covers many preventive services, such as screenings for cancer, heart disease, and diabetes. You can also get an annual wellness visit at no cost. However, coverage isn’t unlimited.

Certain tests and procedures may only be covered if they’re considered medically necessary. For example, Medicare might cover a colonoscopy, but if you need follow-up tests more frequently than guidelines suggest, you may have to pay for them yourself. Some treatments, like experimental procedures, are also not covered under Medicare Part B.

You Might Have to Pay More if You Have a Higher Income

Medicare isn’t a one-size-fits-all program when it comes to costs. If your income is above a certain threshold, you’ll pay higher monthly premiums for Medicare Part B and Part D due to the Income-Related Monthly Adjustment Amount (IRMAA). In 2025, if you earn over $106,000 as an individual or $212,000 as a married couple, expect to pay more for your Medicare coverage.

These extra costs can add up, so if you’re approaching retirement and have a higher income, you might want to consider strategies to reduce your taxable income before signing up for Medicare.

Medicare Enrollment Has Strict Deadlines—And Late Penalties

Signing up for Medicare might seem straightforward, but missing the deadlines can result in lifetime penalties. You’re first eligible to enroll during your Initial Enrollment Period (IEP), which lasts seven months around your 65th birthday (three months before, the month of, and three months after).

If you don’t sign up for Part B when you’re first eligible and you don’t have other qualifying health coverage, you’ll face a 10% penalty for each year you delay enrollment. This penalty is added to your Part B premium for as long as you have Medicare.

Similarly, if you delay enrolling in a Part D plan and don’t have other prescription drug coverage, you’ll pay a late enrollment penalty that increases the longer you wait. These penalties can significantly raise your costs in the long run.

Is Original Medicare the Right Choice for You?

Now that you know these surprising facts, you might be wondering whether Original Medicare is the best choice for your needs. While it offers essential health coverage, it has significant limitations that could leave you paying more than expected.

Many people choose to supplement Original Medicare with additional coverage to fill the gaps. Exploring your options can help you get the coverage you need while keeping costs manageable. If you need help understanding your choices, consider speaking with a licensed agent listed on this website who can guide you through your options.