Free Medicare Gap Analyzer | What Medicare Doesn't Cover
Free Medicare gap analyzer for adult children managing aging parents' coverage. See exactly what Medicare doesn't cover in 3 minutes: long-term care, dental, vision, hearing, and the gaps that catch families flat-footed. No email required.
Common questions
Frequently Asked Questions
What is a Medicare gap?
A Medicare gap refers to the costs and care that traditional Medicare doesn't cover. The biggest gaps are long-term custodial care (bathing, dressing, eating), most dental and vision and hearing, assisted living, memory care, and 24/7 in-home care. Families often discover these gaps only after a parent needs care, when out-of-pocket costs hit $5,000 to $15,000 per month.
Does Medicare cover assisted living?
No. Medicare does not pay for assisted living, ever. It covers limited skilled nursing care after a qualifying hospital stay (capped at 100 days), but custodial care in an assisted living facility is not covered. Medicaid can cover assisted living but only after a 5-year asset look-back and only at facilities that accept Medicaid.
What is the Medicare Part D out-of-pocket cap for 2026?
Starting in 2026, Medicare Part D caps prescription drug out-of-pocket spending at $2,100 per year. AARP estimates about 9 million enrollees will save around $1.5 billion in 2026 because of this change. Hit the cap and the rest of the year is covered.
How do I know if my parent has Medicare Advantage or Original Medicare?
Original Medicare uses red, white, and blue cards from the federal government. Medicare Advantage uses cards from private insurers (UnitedHealthcare, Humana, Aetna, etc.). The difference matters because Medicare Advantage plans often have prior authorization requirements and network restrictions that Original Medicare doesn't.
Who built this Medicare gap analyzer?
Ryan Riggins built this tool based on data from KFF, AARP, and CMS, plus 8+ years of helping families navigate senior housing transitions and Medicare coverage shortfalls. Ryan is a senior transition advisor and former house flipper who switched sides to help families avoid the $50K mistakes most don't see coming.
Topic cluster · Medicare coverage gaps and decoding the system
Related reading
- Blog post
The Medicare Question That Costs Families $10,000: Inpatient or Observation?
Two changes Medicare made in 2026 — the new MOON form deadline on April 20 and the closure of the retrospective patient status appeal window on January 2 — quietly shift $10,000 to $30,000 of rehab cost onto families who don't ask one question at hospital admission: inpatient or observation?
- Blog post
The Hospital Word That Costs Families $40,000 (And Almost Nobody Mentions It)
A neighbor's mom spent 3 nights in the hospital and walked out with a $42,000 bill. Here's the Medicare observation-status trap families don't see coming.
- Blog post
The First 72 Hours After Your Parent Falls: What Nobody Tells You
Your parent just fell. The next 72 hours are critical. Here is the step-by-step action plan most families wish they had before the hospital calls started.
- Guide
Medicare vs. Medicaid for Senior Care: What Each Actually Pays For
Medicare versus Medicaid for senior long-term care, the five-year lookback rule, VA benefits most families miss, and how to coordinate without losing them.
Need help interpreting your results?
Numbers on a page don't decide anything. A 20-minute call will. Walk through what you just saw with Ryan Riggins, Senior Transition Advisor. No sales pressure. Ryan is licensed (Riggins Strategic Solutions, LLC) but does not work as a traditional listing agent.
Not comfortable with a call? Just want to shoot me an email? Reach me at ryan@rigginsstrategicsolutions.com