What Are My Options If Original Medicare Isn’t Enough?
Original Medicare—Parts A and B—is a great start, but for many retirees, it’s not the full solution. It doesn’t cover prescriptions, dental, vision, or hearing. There’s no out-of-pocket limit. And if you need predictable healthcare costs, relying on Original Medicare alone can feel like walking a tightrope without a net.
The good news? You have options. In this guide, we’ll break down the different ways you can fill the gaps, tailor your coverage to your needs, and avoid surprises in retirement.
What Original Medicare Covers (and What It Doesn’t)
Part A (Hospital Insurance) covers:
- Inpatient hospital stays
- Skilled nursing care (short-term)
- Hospice care
- Some home health care
Part B (Medical Insurance) covers:
- Doctor visits
- Outpatient care
- Preventive services
- Medical equipment
But it does not cover:
- Most prescription drugs
- Dental, vision, or hearing care
- Long-term care
- International travel
- An annual out-of-pocket maximum
Common Gaps That Cause Problems
Here are some of the top reasons retirees feel that Original Medicare isn’t enough:
- Expensive deductibles and 20% coinsurance
- No cap on annual out-of-pocket costs
- Prescription drugs not included
- Lack of dental, vision, and hearing coverage
- No help with long-term care
- Complex decisions when adding coverage
If any of these sound familiar, you’re not alone—and you don’t have to settle.
Your Options for Expanding Medicare Coverage
1. Medicare Supplement Insurance (Medigap)
- Fills in cost gaps like deductibles and copays
- Lets you keep Original Medicare and see any doctor who accepts it
- No dental, vision, or drug coverage—must be added separately
2. Medicare Advantage Plans (Part C)
- Combines Part A, Part B, and often Part D into one plan
- May include dental, vision, hearing, fitness benefits
- Generally has lower premiums, but limited to network providers
3. Prescription Drug Plans (Part D)
- Add-on plans to cover medications
- Can be standalone (for Original Medicare) or bundled (in Advantage Plans)
- Penalties apply if you delay enrollment without creditable coverage
4. Medicaid and Medicare Savings Programs
- Help with premiums, copays, and medications if your income is limited
- May qualify for Extra Help with prescription costs
How to Choose: A Simple Decision Tree
Not sure which route is right for you? Use the chart below to identify your needs and the best next step:
(See the Medicare Decision Tree table above to help you decide.)
Real-Life Scenarios
Example 1: Mary is retired, travels frequently, and doesn’t want to worry about network restrictions.
Best fit: Original Medicare + Medigap + Part D plan.
Example 2: John is on a tight budget, wants dental and drug coverage, and doesn’t travel much.
Best fit: Medicare Advantage plan that includes drug and extra benefits.
Example 3: Lynn delayed enrolling in Part D and now needs several prescriptions.
Best fit: Enroll in a Part D plan ASAP to avoid further penalties, and consult an agent for help comparing plans.
Why Work With a Medicare Agent?
Making the wrong Medicare choice can lead to higher costs, limited doctor access, or gaps in your care. Working with a licensed Medicare agent (like Mike Elkin) ensures:
- You know all your options
- You avoid penalties and gaps
- You get year-round support—not just during enrollment
At Elkin Financial, we treat you like family. Mike is nearly retired himself and has helped hundreds of seniors across Indiana make smart, pressure-free Medicare choices. He sticks with you long after enrollment—because retirement healthcare isn't a one-time decision.
Take the Next Step
If you're feeling unsure, confused, or frustrated by Medicare, we’re here to help. Schedule a free consultation with Me
Don’t let confusion cost you coverage. Let’s make Medicare simple—together.