Original Medicare: Parts A & B Explained
The foundation of Medicare coverage — hospital insurance (Part A) and medical insurance (Part B) provided directly by the federal government.
What Is Original Medicare?
Original Medicare is the traditional federal health insurance program that has been available since 1966. It consists of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Together, they provide coverage for hospital stays, doctor visits, outpatient care, preventive services, and more.
Unlike Medicare Advantage (Part C), Original Medicare is administered directly by the federal government — not private insurance companies. This means you can see any doctor or hospital in the country that accepts Medicare, with no network restrictions.
of U.S. physicians accept Medicare
Americans enrolled in Medicare
Serving Americans for nearly 60 years
Part A: Hospital Insurance
Medicare Part A covers inpatient care — hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 10 years (40 quarters).
What Part A Covers
- Inpatient hospital stays
- Skilled nursing facility care (up to 100 days per benefit period)
- Hospice care (comfort care for terminal illness)
- Home health care (limited — must be homebound)
- Inpatient care in a religious nonmedical health care institution
- Blood transfusions (after first 3 pints)
What Part A Doesn't Cover
- Long-term care (custodial/nursing home care)
- Most dental, vision, and hearing services
- Private-duty nursing
- Personal care or homemaker services
- Hospital stays outside the U.S. (with limited exceptions)
Part A Costs in 2026
| Cost Item | 2026 Amount | Notes |
|---|---|---|
| Premium | $0 for most people | Free if you/spouse paid Medicare taxes 10+ years |
| Premium (no work history) | $565/month | If you don't qualify for premium-free Part A |
| Hospital Deductible | $1,736 | Per benefit period (not per calendar year) |
| Days 1–60 Coinsurance | $0/day | After meeting the deductible |
| Days 61–90 Coinsurance | $434/day | For each day of inpatient hospital stay |
| Lifetime Reserve Days (91+) | $868/day | 60 lifetime reserve days total |
| Skilled Nursing (Days 21–100) | $217/day | After first 20 days covered in full |
Part B: Medical Insurance
Medicare Part B covers outpatient medical services — doctor visits, preventive care, lab tests, durable medical equipment, mental health services, and more. Unlike Part A, everyone pays a monthly premium for Part B, and there's a 20% coinsurance with no annual cap.
What Part B Covers
- Doctor and specialist visits
- Outpatient surgery and procedures
- Preventive services (wellness visits, screenings, vaccines)
- Lab tests and diagnostic imaging
- Durable medical equipment (wheelchairs, walkers, etc.)
- Mental health services (outpatient)
- Ambulance services (when medically necessary)
- Home health care (Part B portion)
What Part B Doesn't Cover
- Most dental care (cleanings, fillings, dentures)
- Routine eye exams and eyeglasses
- Hearing aids and hearing exams
- Most prescription drugs (need Part D)
- Cosmetic surgery
- Acupuncture (except for chronic low back pain)
- Routine foot care
Part B Costs in 2026
| Cost Item | 2026 Amount | Notes |
|---|---|---|
| Standard Monthly Premium | $202.90/month | Most beneficiaries pay this amount |
| Annual Deductible | $283 | Must be met before Medicare pays |
| Coinsurance | 20% | You pay 20% of Medicare-approved amount — no cap |
| Outpatient Surgery | 20% | After deductible, in Medicare-approved facilities |
| Doctor Visits | 20% | After deductible for office and specialist visits |
| Durable Medical Equipment | 20% | Wheelchairs, walkers, hospital beds, etc. |
| Clinical Lab Services | $0 | Most lab tests are covered at 100% |
2026 Costs at a Glance
- Part A Premium
- $0for most people
- Part B Premium
- $202.90/mostandard amount
- Hospital Deductible
- $1,736per benefit period
- Part B Deductible
- $283/yrannual deductible
What Original Medicare Doesn't Cover
While Original Medicare provides essential coverage, there are significant gaps you should be aware of. Understanding these gaps is crucial for planning your supplemental coverage needs.
Prescription Drugs
Most outpatient prescription medications require a separate Part D plan.
Dental Care
Routine dental — cleanings, fillings, extractions, dentures — is not covered.
Vision Care
Routine eye exams, eyeglasses, and contact lenses are excluded.
Hearing Aids
Hearing exams for fitting hearing aids and the devices themselves aren't covered.
Long-Term Care
Custodial care in a nursing home or assisted living facility is not covered.
Overseas Care
Healthcare received outside the U.S. is generally not covered (limited exceptions).
Supplementing Original Medicare
Because Original Medicare has no out-of-pocket maximum and doesn't cover prescriptions, dental, vision, or hearing, most beneficiaries add supplemental coverage. Here are your two main options:
Medigap (Medicare Supplement)
Works alongside Original Medicare to cover deductibles, coinsurance, and copays. No networks — see any Medicare provider nationwide.
- Covers Part A & B cost-sharing
- No provider networks
- Predictable monthly costs
- 10 standardized plan options
Or Switch to Medicare Advantage
An alternative to Original Medicare offered by private insurers. Includes Part A, B, usually D, and often dental/vision/hearing.
- Often $0 premium (beyond Part B)
- Includes drug coverage & extras
- Annual out-of-pocket maximum
- Uses provider networks
Frequently Asked Questions
Need Help Understanding Your Options?
Our licensed Medicare agents can help you understand how Original Medicare works with supplemental coverage, compare plans in your area, and find the best fit for your needs — at no cost to you.