The short answer for most people is no. Original Medicare pays a large share of hospital and doctor bills, but it leaves out whole categories of care and puts no ceiling on what you can owe in a year. Here is where the gaps are, with 2026 dollar amounts.
What Original Medicare pays for
Part A is hospital insurance. It covers inpatient stays, a limited amount of skilled nursing facility care after a hospital stay, hospice and some home health care. Most people pay no premium for Part A because they or a spouse paid Medicare taxes while working.
Part B is medical insurance: doctor visits, outpatient care, lab work, preventive services and durable medical equipment. The standard Part B premium in 2026 is $202.90 a month, and people with higher incomes pay more.
What you still pay with Parts A and B
Start with the hospital. In 2026 the Part A deductible is $1,736, and it is charged per benefit period, not per year. Two separate hospital stays months apart can mean paying it twice.
For Part B, you pay a $283 annual deductible and then, for most services, 20% of the Medicare-approved amount. Original Medicare has no annual out-of-pocket maximum. Twenty percent of an office visit is small. Twenty percent of chemotherapy or a long course of outpatient treatment is not.
Skilled nursing care is covered only after an inpatient hospital stay of at least three days in a row, and only for a limited time. You pay $0 a day for the first 20 days and $217 a day for days 21 through 100. After day 100, Medicare pays nothing.
What Medicare doesn’t cover at all
Original Medicare doesn’t include the prescriptions you take at home. That takes a separate Part D plan, or a Medicare Advantage plan with drug coverage. It also doesn’t pay for most routine dental care, eye exams for glasses, or hearing aids. And it doesn’t pay for long-term custodial care, meaning help with bathing, dressing and other daily activities, whether at home or in a nursing facility.
Part D has its own numbers. In 2026 no drug plan can have a deductible above $615, and once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for covered drugs for the rest of the year.
Two ways to fill the gaps
A Medicare Supplement (Medigap) policy works alongside Original Medicare and pays some or all of the deductibles and the 20% coinsurance, depending on the plan letter. You keep the freedom to see any provider that accepts Medicare, and you add a Part D plan for prescriptions.
A Medicare Advantage plan (Part C) replaces Original Medicare with a private plan. These plans must cap your yearly out-of-pocket costs for Part A and Part B services, and many include drug coverage plus some dental, vision or hearing benefits. The trade-off is usually a provider network and plan rules such as prior authorization.
Connecticut residents have an advantage here. Under Connecticut law, Medigap policies are sold on a guaranteed-issue basis all year and are community rated, so an insurer can’t turn you down because of your health or set your premium by your age. In most states that protection lasts only for a short window when you first enroll. Here, a choice you make at 65 is easier to revisit later.
What to do with this
Add up what a bad year would cost under each option, not just the monthly premium. Check that your doctors and prescriptions are covered. Then look again each fall, because premiums, drug lists and networks change every year. Our guide on how often you should update your insurance plan covers the timing.
Long-term care is the one gap that neither Medigap nor Medicare Advantage closes. We cover that separately on our long-term care insurance page.
The dollar amounts above are for 2026 and change every year. If you’d like help comparing the plans available where you live, call The Jones Group at (860) 529-3788.
