Medicare Parts A & B:
Original Medicare Explained
Part A covers hospital stays. Part B covers doctor visits. Together they form the foundation that everything else in Medicare is built on. Here’s what you need to know in 2026.
What Is Original Medicare?
Original Medicare is the federal health insurance program that’s been around since 1966. It’s administered directly by the government (through the Centers for Medicare & Medicaid Services, or CMS) and is available to most Americans when they turn 65.
It has two parts:
- Part A:Hospital insurance. Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.
- Part B:Medical insurance. Covers doctor visits, outpatient care, preventive services, medical equipment, and some home health services.
Together, Parts A and B are called “Original Medicare.” They cover roughly 80% of your approved medical costs. The remaining 20%, plus deductibles and other gaps, is your responsibility unless you add supplemental coverage (Medigap or Medicare Advantage).
Key point: With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare. There are no provider networks and no referral requirements.
Part A: Hospital Insurance
What Part A Covers
- Inpatient hospital stays:semi-private room, meals, nursing care, drugs administered during your stay, and other hospital services
- Skilled nursing facility (SNF) care:up to 100 days per benefit period after a qualifying 3-day inpatient hospital stay. Days 1-20 are fully covered after the Part A deductible. Days 21-100 require a daily coinsurance of approximately $209.50/day.*
- Hospice care:comfort care for terminal illness, including medications for symptom management
- Home health care:limited skilled nursing and therapy services when you’re homebound
Part A Costs in 2026
| Cost | 2026 Amount | Notes |
|---|---|---|
| Premium (40+ quarters) | $0* | You (or your spouse) paid Medicare taxes for 10+ years |
| Premium (30-39 quarters) | $284/month* | Reduced premium for those with 7.5-10 years of work history |
| Deductible | $1,676 per benefit period* | Applies each time you’re admitted to a hospital |
| Days 1-60 | $0 coinsurance* | After deductible is met |
| Days 61-90 | $419/day* | Daily coinsurance kicks in |
| Days 91-150 | $838/day* | Lifetime reserve days (60 total, non-renewable) |
| Beyond 150 days | You pay 100% | No Medicare coverage after reserve days are used |
Watch out: The Part A deductible resets every benefit period (not every calendar year). A benefit period starts when you’re admitted and ends when you’ve been out of the hospital or SNF for 60 consecutive days. If you’re readmitted after 60 days, you pay the $1,676 deductible again.
Part B: Medical Insurance
What Part B Covers
- Doctor visits:office visits, specialist consultations
- Outpatient care:surgery, lab tests, X-rays, MRIs, outpatient rehab
- Preventive services:annual wellness visits, screenings (mammograms, colonoscopies, flu shots), diabetes management
- Durable medical equipment (DME):wheelchairs, walkers, oxygen equipment
- Mental health services:outpatient therapy, psychiatric visits
- Ambulance services:when medically necessary
Part B Costs in 2026
| Cost | 2026 Amount | Notes |
|---|---|---|
| Standard premium | $185.00/month* | Deducted from Social Security check (or billed directly if not yet receiving SS) |
| Annual deductible | $257* | Once per calendar year |
| Coinsurance | 20% of approved amount* | After deductible, you pay 20% (no cap) |
| IRMAA surcharge | $74.00 – $443.90 extra/mo* | If your income exceeds $106,000 (single) or $212,000 (joint) |
The 20% problem: Part B’s 20% coinsurance has no annual out-of-pocket maximum. If you need a $100,000 surgery, you could owe $20,000 with no cap. This is exactly why most people add a Medigap supplement to cover that 20%.
Want to see how this applies to your situation?
2026 Costs at a Glance
| Part A | Part B | |
|---|---|---|
| Monthly premium | $0 (most people)* | $185.00* |
| Annual deductible | $1,676 per benefit period* | $257 per year* |
| Your cost after deductible | $0 for days 1-60 | 20% coinsurance (no cap) |
| Maximum out-of-pocket | No cap | No cap |
What Original Medicare Doesn’t Cover
This is where people get surprised. Original Medicare does not cover:
- Dental care:routine cleanings, fillings, dentures, extractions
- Vision care:eye exams for glasses, eyeglasses, contacts
- Hearing care:hearing exams, hearing aids, fitting
- Long-term care:custodial care in nursing homes or assisted living (not the same as skilled nursing)
- Care outside the U.S.:with rare exceptions
- Cosmetic procedures
For dental, vision, and hearing, you’ll need to add standalone DVH plans or choose a Medicare Advantage plan that bundles these benefits.
Filling the Gaps: Your Two Paths
Once you have Original Medicare, you have two paths to fill the coverage gaps:
Path 1: Original Medicare + Medigap + Part D
How it works: You keep Original Medicare and add supplemental coverage. No provider networks. Predictable costs. Freedom to see any doctor who accepts Medicare.
- Keep Parts A & B (Original Medicare)
- Add a Medigap supplement (e.g., Plan G or Plan N) to cover the 20% coinsurance and deductibles
- Add a standalone Part D plan for prescription drug coverage
Path 2: Medicare Advantage (Part C)
How it works: A private plan replaces Original Medicare and typically bundles medical, drug, and sometimes dental, vision, and hearing coverage. Often lower monthly premiums, but with provider networks and copays.
- Replace Original Medicare with a Medicare Advantage plan (you still have Parts A & B, but the Advantage plan manages your benefits)
- Most Advantage plans include Part D drug coverage
- May include dental, vision, hearing, gym memberships, and other extras
Neither path is universally “better.” Your health, medications, doctors, and budget determine which is right. That’s what our workshop and advisors help you figure out.
How to Enroll in Original Medicare
Most people are automatically enrolled in Part A when they turn 65 (if they’re already receiving Social Security). Part B enrollment depends on your situation:
- Turning 65 and already on Social Security: You’ll be auto-enrolled in both Parts A and B. Your Medicare card arrives about 3 months before your birthday.
- Turning 65 and not on Social Security: You need to actively sign up during your Initial Enrollment Period (IEP), the 7-month window around your 65th birthday.
- Still working past 65 with employer coverage: You may be able to delay Part B without penalty. But the rules depend on your employer’s size. Read the turning-65 guide →
Don’t miss the window. If you don’t sign up for Part B when you’re first eligible and don’t have qualifying employer coverage, you’ll pay a 10% late enrollment penalty for every 12-month period you delayed. This penalty is permanent. You pay it every month for as long as you have Part B.
Not sure when you should enroll? We’ll tell you.
Frequently Asked Questions
Most people don’t pay a Part A premium because they (or their spouse) paid Medicare taxes for at least 40 quarters (10 years). If you have 30-39 quarters, you pay a reduced premium of approximately $284/month.* If you have fewer than 30 quarters, the full premium is up to $518/month.*
A deductible is a fixed amount you pay before Medicare starts covering costs. Coinsurance is the percentage you pay after the deductible is met. For Part B, the deductible is $257/year.* After that, you pay 20% of the Medicare-approved amount for most services.
Yes. Any doctor or hospital in the United States that accepts Medicare. No networks, no referrals needed for specialists. The vast majority of physicians nationwide accept Medicare assignment.
No. Original Medicare has no annual out-of-pocket maximum. Your 20% coinsurance on Part B has no cap. This is the primary reason most people on Original Medicare add a Medigap supplement to protect from catastrophic costs.
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on your Part B (and Part D) premiums if your income exceeds certain thresholds. In 2026, the surcharge starts if your modified adjusted gross income exceeded $106,000 (single) or $212,000 (joint) on your tax return from 2 years ago.* Talk to one of our advisors to learn how IRMAA applies to your situation.
Sources
* All 2026 Medicare cost figures sourced from the Centers for Medicare & Medicaid Services (CMS):
Part A costs: cms.gov/newsroom/fact-sheets/2026-medicare-parts-a-b-premiums-and-deductibles
Part B premiums and deductibles: cms.gov/newsroom/fact-sheets/2026-medicare-parts-a-b-premiums-and-deductibles
IRMAA brackets: cms.gov/medicare/costs/medicare-premium-income-related-monthly-adjustment-amounts
SNF coinsurance: cms.gov/newsroom/fact-sheets/2026-medicare-parts-a-b-premiums-and-deductibles
General Medicare information: medicare.gov/basics/get-started-with-medicare
All figures should be verified against the latest CMS fact sheet at cms.gov before relying on them for enrollment decisions.
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