Medicare is solid health insurance for most people who qualify. It covers hospital stays, doctor visits, lab tests, and preventive care, and 98% of non-pediatric physicians in the U.S. accept it. In a Commonwealth Fund survey, 65% of Medicare beneficiaries said their coverage fully met their expectations. But “good” depends on your health needs and how much you’re willing to spend on premiums and supplemental plans to fill its gaps, because Medicare on its own has some significant holes.
What Medicare Covers Well
Original Medicare comes in two parts. Part A handles inpatient hospital care, skilled nursing facility stays, hospice, and some home health services. Part B covers doctor visits, outpatient procedures, diagnostic tests, and preventive services like screenings and vaccinations. Together, they form a broad safety net for the kinds of care people use most as they age.
One of Medicare’s biggest strengths is provider access. You can see any doctor or visit any hospital in the country that accepts Medicare, with no referrals and no network restrictions. Only 1.2% of non-pediatric physicians have formally opted out of the program, so in practice you’ll rarely run into a provider who won’t take your coverage. Even in the states with the highest opt-out rates (Washington, D.C. at 2.9% and Alaska at 2.8%), the vast majority of doctors participate. In 12 states, the opt-out rate is 0.5% or lower.
The Notable Gaps
Original Medicare does not cover several categories of care that many older adults need regularly:
- Dental care: routine cleanings, fillings, tooth extractions, and dentures
- Vision: eye exams for prescription glasses and the glasses themselves
- Hearing: hearing aids and the exams to fit them
- Long-term care: custodial care in a nursing home or assisted living facility
These exclusions catch a lot of people off guard. Dental work alone can run thousands of dollars a year, and long-term care costs can be financially devastating. If you need coverage in any of these areas, you’ll have to buy separate insurance or choose a Medicare Advantage plan that includes those benefits.
The Out-of-Pocket Problem
Perhaps the most important thing to understand about Original Medicare is that it has no annual cap on what you pay out of pocket. If you’re hospitalized multiple times or need expensive treatments, your 20% coinsurance on Part B services keeps accumulating with no ceiling. This is unusual compared to most employer-sponsored and marketplace plans, which are required to cap yearly out-of-pocket costs.
You can fix this by adding a Medigap (Medicare Supplement) policy. These plans, sold by private insurers, cover some or all of the coinsurance, copayments, and deductibles that Original Medicare leaves behind. The most comprehensive Medigap plans pay 100% of your Part B coinsurance. More limited plans like Plan K cover 50% of coinsurance but include their own out-of-pocket cap ($8,000 in 2026). Medigap premiums vary by plan type, your age, and where you live, but they provide the financial protection that Original Medicare lacks on its own.
Medicare Advantage: A Different Approach
About half of Medicare beneficiaries now choose Medicare Advantage instead of Original Medicare. These are private insurance plans that must cover everything Original Medicare covers but often add dental, vision, hearing, and fitness benefits. They also include a yearly out-of-pocket maximum, which Original Medicare doesn’t have.
The trade-off is flexibility. Medicare Advantage plans typically restrict you to a network of doctors and hospitals. If you see an out-of-network provider for non-emergency care, you’ll pay more or the visit may not be covered at all. Access to care is comparable between the two options: about a third of beneficiaries in both Original Medicare and Medicare Advantage report waiting more than a month to see a doctor. The satisfaction rate (65% saying coverage fully meets expectations) is also similar across both.
What It Costs in 2025
Part A is premium-free for most people who paid Medicare taxes for at least 10 years. Part B costs $185 per month in 2025 for individuals earning $106,000 or less ($212,000 or less for couples filing jointly). That’s the standard premium, and about 92% of beneficiaries pay it.
Higher earners pay more through income-related surcharges. The premium tiers scale up significantly: an individual earning between $133,000 and $167,000 pays $370 per month for Part B, and someone earning $500,000 or more pays $628.90 per month. Similar surcharges apply to Part D prescription drug plans, adding up to $85.80 per month at the highest income level. These adjustments are based on your tax return from two years prior.
Prescription Drug Coverage
Original Medicare doesn’t include prescription drug coverage. You need to add a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage. Part D plans are sold by private insurers, and premiums vary by plan and region.
A major improvement took effect in 2025: yearly out-of-pocket costs for prescription drugs are now capped at $2,000 under Part D. Before this change, people taking expensive medications could face costs of $10,000 or more per year once they hit the coverage gap. This $2,000 cap is one of the most significant upgrades to Medicare in recent years and makes a real difference for anyone on costly prescriptions.
How Medicare Compares Overall
Compared to being uninsured or underinsured, Medicare is excellent. It provides broad access to providers, covers the most expensive types of care (hospitalizations, surgeries, cancer treatment), and charges premiums that are modest relative to what younger adults pay on the individual market. The new $2,000 drug cost cap adds meaningful financial protection that didn’t exist a few years ago.
Compared to a generous employer plan, Original Medicare by itself has weaknesses: no dental, no vision, no hearing, no out-of-pocket maximum, and no drug coverage unless you add it. But Original Medicare paired with a Medigap policy and a Part D plan starts to look quite competitive. You get nationwide provider access with no network restrictions, comprehensive hospital and outpatient coverage, coinsurance protection, and capped drug costs. The total monthly cost of premiums for all three pieces typically ranges from $300 to $500 depending on your Medigap plan and location.
Medicare Advantage bundles more benefits into a single plan at a lower premium (sometimes $0 beyond your Part B premium), but you give up the freedom to see any doctor anywhere. Which path is “better” depends on whether you value provider choice or lower premiums and extra benefits like dental. Neither option is clearly superior for everyone, which is why satisfaction rates are nearly identical across both.