Filling the Gaps in Your Medicare Coverage: How to Save Thousands Each Year

If you're approaching Medicare eligibility or already enrolled, you've likely discovered that Medicare doesn't cover all your healthcare expenses. In fact, Original Medicare typically covers only about 80% of your medical costs, leaving you responsible for significant out-of-pocket expenses that can quickly add up to thousands of dollars annually.

The good news is that you have options to fill these coverage gaps and protect your retirement savings from unexpected medical bills. Understanding these solutions can help you make informed decisions that safeguard your financial security while ensuring you receive the healthcare you need.

Understanding Medicare's Coverage Gaps

Medicare's structure creates several areas where you'll face out-of-pocket costs. Original Medicare Part A (hospital insurance) and Part B (medical insurance) work together, but they don't provide complete coverage for your healthcare needs.

Part B Coverage Limitations

Medicare Part B covers 80% of approved medical services, including doctor visits, outpatient procedures, and medical equipment. However, you're responsible for the remaining 20% coinsurance plus the annual Part B deductible, which increased to $257 in 2025. For major medical procedures, that 20% can translate to thousands of dollars in unexpected expenses.

Services Medicare Doesn't Cover

Medicare excludes several important healthcare services that many seniors need:

• Dental care and dentures
• Vision care and eyeglasses
• Hearing aids and hearing exams
• Long-term care services
• Cosmetic surgery
• Acupuncture (in most cases)
• Healthcare while traveling outside the United States

Prescription Drug Coverage Gaps

While Medicare Part D provides prescription drug coverage, changes in 2025 have restructured how costs work. The previous "donut hole" coverage gap has been eliminated, and out-of-pocket spending is now capped at $2,000 annually. Despite this improvement, you'll still face monthly premiums, deductibles, and copayments before reaching the catastrophic coverage threshold.

Medigap: Your Primary Solution for Coverage Gaps

Medicare Supplement insurance, commonly called Medigap, is specifically designed to fill the gaps left by Original Medicare. These standardized plans work alongside your Medicare benefits to reduce or eliminate your out-of-pocket costs.

How Medigap Works

When you receive medical care, Medicare pays its portion first, then your Medigap plan pays its share according to your plan's benefits. This coordination means you'll face fewer surprise bills and have more predictable healthcare costs throughout the year.

Popular Medigap Plan Options

Plan G is currently the most popular choice for new Medicare beneficiaries. It covers:

• Part A coinsurance and hospital costs
• Part B coinsurance (the 20% Medicare doesn't cover)
• First three pints of blood
• Part A hospice care coinsurance
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B excess charges (when doctors charge more than Medicare's approved amount)

The only gap Plan G doesn't cover is the Part B deductible ($257 in 2025), which you'll pay out-of-pocket.

Plan F and Plan C offer more comprehensive coverage, including the Part B deductible, but these plans are only available if you were eligible for Medicare before January 1, 2020. If you qualify for these plans, they provide the most complete coverage available.

Plan N offers a lower-premium alternative that covers most Medigap benefits but requires small copayments for doctor visits and emergency room visits that don't result in admission.

Medicare Advantage: An Alternative Approach

Medicare Advantage plans provide another way to address Medicare's coverage gaps. These private insurance plans replace your Original Medicare benefits and often include prescription drug coverage, dental, vision, and hearing benefits in one package.

Key Advantages of Medicare Advantage

• Out-of-pocket maximums: Unlike Original Medicare, these plans cap your annual expenses, providing financial protection against catastrophic medical costs
• Additional benefits: Many plans include services Original Medicare doesn't cover, such as dental cleanings, eye exams, and wellness programs
• Coordinated care: Plans often emphasize preventive care and care coordination through their provider networks

Important Considerations

Medicare Advantage plans typically require you to use their network of providers and may need referrals for specialist care. Additionally, plan benefits and costs can change annually, requiring you to review your coverage each year during the open enrollment period.

Strategies to Maximize Your Medicare Savings

Shop During Annual Open Enrollment

Medicare's Annual Open Enrollment Period (October 15 - December 7) gives you the opportunity to review and change your coverage. Even if you're satisfied with your current plan, comparing options annually can reveal better benefits or lower costs that could save you hundreds of dollars.

Take Advantage of Free Preventive Services

Medicare covers numerous preventive services at no cost to you, including:

• Annual wellness visits
• Screening tests for various conditions
• Vaccines and immunizations
• Counseling services for tobacco cessation and obesity

Using these services helps you stay healthy while maximizing your Medicare benefits.

Use In-Network Providers

If you choose a Medicare Advantage plan, staying within your plan's provider network helps you avoid unexpected charges. Before scheduling appointments, verify that your doctors and facilities participate in your plan's network.

Consider Telehealth Options

Many Medicare plans now cover telehealth services, which can be more convenient and cost-effective than in-person visits for routine care, follow-ups, and prescription consultations.

Appeal Denied Claims

If Medicare or your supplemental plan denies coverage for a service you believe should be covered, you have the right to appeal. Working with your healthcare provider to provide additional documentation often leads to successful appeals and significant savings.

2025 Medicare Updates That Affect Your Costs

The Inflation Reduction Act has brought important changes to Medicare Part D that can help reduce your prescription drug costs. The elimination of the coverage gap and the $2,000 annual out-of-pocket cap provide significant financial protection for beneficiaries with high medication costs.

Additionally, you can now spread your prescription costs throughout the year with monthly payment options, making expensive medications more manageable for your budget.

The standard Part B premium for 2025 is $185 monthly, representing an increase from the previous year. However, the annual Part B deductible remains relatively modest at $257.

Making the Right Choice for Your Situation

Choosing between Medigap and Medicare Advantage depends on your individual healthcare needs, budget, and preferences. Consider these factors:

Choose Medigap if you:

• Want the freedom to see any doctor who accepts Medicare
• Prefer predictable costs with minimal surprises
• Have chronic conditions requiring frequent specialist care
• Travel frequently and want coverage anywhere in the United States

Choose Medicare Advantage if you:

• Want additional benefits like dental and vision in one plan
• Prefer lower monthly premiums with annual out-of-pocket maximums
• Are comfortable using a network of providers
• Value care coordination and wellness programs

Getting Expert Guidance

Navigating Medicare's complexities can feel overwhelming, but you don't have to make these important decisions alone. At Borde & Associates, we specialize in helping individuals understand their Medicare options and find coverage solutions that protect both their health and their financial security.

Our experienced team can help you compare plans, understand costs, and identify strategies to maximize your Medicare benefits while minimizing your out-of-pocket expenses. We're committed to providing you with the personalized guidance you need to make confident decisions about your healthcare coverage.

Contact us today to schedule a consultation and learn how we can help you fill the gaps in your Medicare coverage while potentially saving thousands of dollars each year. Visit our Medicare options page or contact us directly to get started.

Remember, the decisions you make about Medicare coverage today will impact your healthcare costs for years to come. Taking the time to understand your options and work with knowledgeable professionals ensures you'll have the coverage you need at a price you can afford.

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