Understand Coverage Gaps

Text Size
Print

Original Medicare may leave you with some unpredictable out-of-pocket medical costs due to gaps in the coverage it offers.


Gaps in Original Medicare

Here we list some of the out-of-pocket costs you may have to pay when you only have Original Medicare Parts A and B.
  • 1. Prescription Drugs

  • 2. Dental

  • 3. Vision

  • 4. Hearing Aids


3 ways to make your coverage more robust than Original Medicare

There are a variety of private insurance plans that may help fill the gaps in your healthcare coverage.

Compare all your coverage options

See a breakdown of what is covered and what isn’t covered by each type of plan.

Swipe to compare more plans

Original Medicare Parts A and B
Humana Stand-alone Prescription Drug Plans Part D
All-in-one Humana Medicare Advantage Prescription Drug Plans
Humana Medicare Supplement Plans
Part A

Part A

Hospital expenses, skilled nursing, home health care, and hospice care

Part B

Part B

Doctor visits, outpatient care, and preventative services

Prescription Drugs

Prescription Drugs

Coverage for your medications

$0 Plan Premiums

$0 Plan Premiums

Monthly premiums that cost as low as $0/month

Predictable Costs

Predictable Costs

Limits on the maximum amount you’ll pay out-of-pocket

More Coverage

More Coverage

Choose from plans that may include routine dental, vision, and hearing aid coverage built right in.

Extra Benefits

Extra Benefits

Extra benefits and services at no extra cost.

Travel Flexibility

Travel Flexibility

Coverage anywhere in the U.S., and emergency care abroad

No Paperwork

No Paperwork

Avoid filling out tedious claims

Plan ID card

Plan ID card

A single card to show at time of care

No Referrals Required

No Referrals Required

Choose from plans that won’t require referrals

No Network Restrictions

No Network Restrictions

Choose any doctor that accepts Medicare


Which to choose: Medicare Advantage vs. Medicare Supplement

We break down the differences to help make your decision easier

Medicare Advantage (Part C)

Medicare Supplement (Medigap)

Medicare Advantage (Part C)

Medicare Advantage plans combine all the benefits of Original Medicare Parts A and B, and may include your Part D Prescription Drug coverage built right in. Plus, some plans will include routine dental and vision coverage, and other extra benefits, all for a monthly plan premium.

  • Do I Keep My Part A and B Coverage? - Your Medicare Advantage plan will replace your Original Medicare Part A & Part B coverage, but you won’t lose a single benefit. In fact, you may get more. That’s because rather than pay your medical bills directly, the federal government contracts with private insurance companies such as Humana to administer your plan.
  • How does the plan work to lower my out of pocket costs? - Insurance companies compete for your business with affordable premiums and added benefits. The cost of care will be determined by your plan and you will no longer be responsible for the out of pocket costs outlined by Original Medicare – with the exception of your monthly Part B premium. All Medicare Advantage plans include a maximum out of pocket limit which caps your annual out-of-pocket costs so you'll never be charged more than this total amount for covered care each year.
  • Will I get access to additional coverage and extra benefits? - Prescription drug, routine dental, vision, and hearing aid coverage are included with some Medicare Advantage plans. Just be sure to check the plan you are interested in includes this coverage. You will also have the option to add on additional coverage for more complex dental procedures if your plan doesn’t cover them directly.
  • Will I get to keep my doctor and will I need a referral to see a specialist? - To help manage costs, Medicare Advantage plans usually enter into contracts with a network of doctors and hospitals. That means you’ll generally pay less when you receive care from doctors and specialists who accept your plan. Humana has large networks of approved doctors and hospitals so be sure to check yours are covered on the plan before you enroll. If you choose an HMO plan you may need a referral to use an in-network specialist, but referrals should not be required on PPO plans.
  • What monthly plan premium will I pay? - Medicare Advantage plans generally have a lower premium than Medicare Supplement plans. In fact, many Medicare Advantage plans have no monthly premium at all.
  • When can I enroll? - You can enroll or change plans two times a year. First during the annual enrollment period from Oct 1 – Dec 7 and then again during Open Enrollment from Jan 1 – March 31. From April 1 – Oct 1 you will need a special enrollment period to switch plans. If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare.
  • Can I change my plan later? - If you want to switch to a different Medicare Advantage or Prescription Drug plan you’ll be able to make that change during annual enrollment each year. While you won’t be able to enroll for the first time, if you are already enrolled in a Medicare Advantage plan on January 1st you’ll be able to switch to a different plan during the Open Enrollment Period, which ends on March 31st each year. Outside of that time, you’ll need to have a valid reason to make a change. During these enrollment periods, you have the option to switch back to Original Medicare parts A and B, and if needed, add a Medicare Part D plan.
  • Why would I choose a Medicare Advantage Prescription Drug Plan? - Medicare Advantage Prescription Drug plans may be ideal for people who want an all-in-one plan that will cover all of their health and medication needs in one. There are many Medicare Advantage Prescription Drug plans to choose from so enrollees can ensure they choose the one that covers all the added benefits and services they need to help maintain their health and stay within their budget.
  • Why wouldn’t I choose Medicare Advantage? - Medicare Advantage plans rely on networks of approved doctors and hospitals to keep costs affordable and provide additional benefits. If your doctor is not in your plan’s network of providers, you may have higher costs. Your out-of-pocket costs may be lower if you receive care from in-network providers.

Medicare Supplement (Medigap)

Medicare Supplement plans are standardized. They are labeled by letters (A-N). All Health Insurance companies must offer the same basic coverage for each plan. Companies compete for your business based on the monthly premium and other additional benefits beyond this base requirement. Medicare Supplement plans cannot be combined with a Medicare Advantage plan. These plans are separate and you cannot be enrolled in both at the same time.

  • Do I Keep My Part A and B Coverage? - Yes. You keep your Part A and B coverage. Your Medicare supplement plan gets added on to help pay out of pocket costs.
  • How does the plan work to lower my out of pocket costs? - MedSupp helps pay out-of-pocket costs not paid by Original Medicare (Parts A and B), like your part A deductibles and co-insurance. Typically, the higher the plan premium the lower your out- of-pocket "usage" charges will be. With some plans you can offset your monthly premium with a deductible that gets met before the plan covers the rest of your original Medicare expenses.
  • Will I get access to additional coverage and extra benefits? - Medicare supplement plans don’t typically cover prescription drugs or dental, vision, and hearing care. You won’t usually get extra benefits or services with these plans. However, Humana offers stand-alone plans you can purchase separately to get this added coverage.
  • Will I get to keep my doctor and will I need a referral to see a specialist? - There are no network restrictions with a Medicare Supplement plan. You may visit any Doctor or hospital of your choosing as long as they accept Medicare patients. You can see specialists without referrals.
  • What monthly plan premium will I pay? - The cost of your premium depends on the plan you choose. Your age, location, sex, and other items may be a factor as well. Premiums typically range between $50 and $250 a month. You must continue to pay your Original Medicare Part B premium as well.
  • When can I enroll? - Medicare Supplement Plans are sold year round. You can apply to buy a Medicare supplement insurance plan any time after you turn 65 and join Medicare Part B - there is no need for a special enrollment period. In many cases, however, pricing will be more favorable if you purchase a plan during your Medigap Open Enrollment Period. This period lasts 6 months after you enroll in Part B. Stand-alone prescription drug plans.
  • Can I change my plan later? - You can switch or cancel your Medicare Supplement plan at any time for any reason. In some instances you may be required to go through underwriting for your new plan if you are outside a guaranteed issue right.
  • Why would I choose this plan? - These plans make your costs very predictable. They are great for people who prefer to steadily budget higher premium costs instead of paying each time they use their plan. These plans are also nice for people who want the flexibility to choose any doctor, hospital, or facility they want to use and are able to afford a higher premium in exchange for this flexibility. Why wouldn’t I choose this plan? - On average, Medicare Supplement plans have higher monthly plan premiums than Medicare Advantage plans. These plans won’t cover your prescription drug, dental, vision, hearing, or other supplemental care so you’ll need to enroll in that coverage separately. They also won’t provide access to additional benefits and services that have become standard on most Medicare Advantage plans.

Intro Image

How well do you know your Medicare coverage options?

Take our 10-question quiz to find out. 


Congrats! You’ve completed Step 3!

Next Step

Step 4: Explore Medicare Advantage

Let’s find your plan, however you prefer

Choose Your Plan-CardImage1.png
Guidance to do it yourself

Compare plans and enroll online. We'll guide you along the way

Shop Plans
Choose Your Plan-CardImage2.png
One to one support

Enroll with a licensed sales agent right over the phone.

TTY:771

8 AM – 8 PM, Mon – Fri

Local licensed sales agents you can trust

Meet with your local Humana MarketPoint® sales agent.

Schedule an Appointment

Virtually or in person

https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html 

2 https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

3 https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

4 https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html

5 https://www.medicare.gov/coverage/inpatient-hospital-care

6 https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

7 https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html