Original Medicare: Part A and Part B
Learn about Medicare Part A & Part B, also known as Original Medicare, and its guidelines, eligibility, and benefits
Understanding Medicare Part A & Part B (Original Medicare)
Original Medicare or Traditional Medicare is the industry term for Medicare Part A and Part B. Part A and Part B were the initial social insurance programs administered by the federal government signed into law in 1965. Part A is hospital insurance — covering hospital stays — and Part B covers medical services and products (such as doctors visits, diabetes supplies, and more). Together, Parts A and B are offered to those 65 years of age and older or those who qualify through certain disabilities like end-stage renal disease and ALS (Lou Gehrig’s Disease). Medicare has over 55 million beneficiaries nationwide.
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What is Covered by Medicare Part A & Part B?
Original Medicare (Part A and Part B) provides eligible individuals healthcare coverage and access to healthcare providers at a cost. Beneficiaries can visit any hospital in the United States that accepts Medicare, and Medicare will cover its portion of the bill for any Medicare-covered service and the beneficiary will be in charge of the rest (unless they have a Medigap plan that covers the extra costs).
Hospital Insurance
Part A is hospital insurance. Part A, often called hospital insurance, is a crucial component of Original Medicare. It primarily covers inpatient care in hospitals, including semi-private rooms, meals, nursing services, and medications administered during your stay. Beyond acute hospital care, Part A also extends to skilled nursing facility care for a limited time after a qualifying hospital stay, hospice care for terminally ill patients, and some home health care services. It's important to understand that while Part A covers the bulk of inpatient services, it typically does not cover personal care services in nursing homes or long-term care, nor does it cover private duty nursing or a private room unless medically necessary.
Medical Insurance
Part B, also known as medical insurance, covers a broad range of medically necessary services and supplies that are not covered by Part A. This includes doctor's visits, outpatient care, preventive services (like flu shots and certain cancer screenings), durable medical equipment (such as wheelchairs and oxygen tanks), and mental health services. It also helps cover clinical research, ambulance services, and some home health services. While Part B is comprehensive for outpatient care, beneficiaries typically pay a monthly premium, an annual deductible, and a 20% coinsurance for most Medicare-approved services after the deductible is met. One unique service to Medicare Part B is the annual wellness visit where your physician assesses physical and mental health.
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Learn More About Annual Wellness Visits Under Part B
What does Original Medicare not cover?
Original Medicare was designed to cover basic services and hospital stays, assuming that most citizens with enough work history had pensions, retirement funds, or even employer coverage through retirement to pay for their more routine and specialized care. However, it became clear over time that most seniors would need additional insurance to cover their holistic health.
Private insurance plans like Medicare Supplement, Medicare Part D, and Medicare Advantage plans have emerged to fill in these gaps.
Medicare Supplement plans are private insurance plans offered by insurance companies to cover the services above, and out-of-pocket costs such as the 20% co-insurance after you’ve met your Part B deductible.
Medicare Part D plans are private insurance plans that cover prescriptions and supplies that are not covered by Part B. Further, a commonly-overlooked area of coverage for many beginning Medicare for the first time is dental, vision, or hearing insurance.
Medicare Advantage are also private insurance plans and include multiple types like PPO and HMO plans that will be familiar to you if you have had group coverage. Medicare Advantage covers everything Part A and Part B cover, and typically includes additional coverage for dental, vision, and hearing. Some Medicare Advantage plans have prescription coverage included and may cover additional expenses for health like grocery and over-the-counter healthcare products. Medicare Advantage plans may have more affordable premiums compared to Medicare Supplement, but tend to include higher copayments and co-insurance than Medicare Supplement. So it’s important to assess healthcare coverage and costs across multiple plan options.
What is the cost of Medicare Part A & Part B?
Original Medicare does not cover the full cost of most treatments and beneficiaries are required to pay premiums and deductibles. These costs change each year and are published annually by the Centers for Medicare & Medicaid Services. The amount you pay for co-insurance will depend on the total cost of the services, which can vary by provider and location.
The costs below are only for procedures and conditions that Medicare covers, or procedures that are deemed “medically necessary.” Medicare defines healthcare services and supplies as medically necessary if they are required to diagnose or treat an illness or injury, condition, disease or its symptoms or if it meets accepted medical standards. So while routine dental care isn’t covered under the medically necessary standard, a tooth extraction for radiation treatment would be.
Should you ever wish to file an appeal regarding a specific service claim, Medicare has a specific process to follow.
Here’s a look at the 2026 costs for Original Medicare. It’s important to note that this is the base premium for Part B, but if you are a higher earner, you will pay more for Part B. And if you do not have it deducted from your Social Security check, Medicare will send you a quarterly bill — meaning that you will have to pay multiple months in a sum, which can be a big bill! So it’s important to understand what you will have to pay and budget ahead of time.
| Cost-sharing 2026 | Part A | Part B |
|---|---|---|
| Monthly premium | $565* | $202.90** |
| Annual deductible | $1,736 | $283 |
| Co-insurance and Other costs (Costs you incur) | $434/day for days 61-90 in hospital $868/day for lifetime reserve days |
20% of the service after you pay the deductible |
How to Enroll in Medicare Part A & Part B?
Enrolling in Medicare Part A and Part B typically occurs automatically for those receiving Social Security or Railroad Retirement Board benefits as they approach 65. If you're not receiving these benefits, you'll need to sign up through the Social Security Administration website, by phone, or in person during your Initial Enrollment Period. While Original Medicare provides essential coverage, it's important to remember that it doesn't cover all healthcare costs. When considering additional services or supplemental insurance options, navigating the various plans can be complex, and having a knowledgeable guide can be invaluable in comparing choices and finding the right fit for your needs.
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What is included in Medicare Part A?
- Inpatient hospital care, including tests, services, and some transfusions
- Stays in hospitals and skilled nursing facilities up to benefit limits
- Some home health care services, including rehabilitation
- Hospice care
- Necessary medical supplies and drugs administered during stay
Medicare Part A does NOT cover
- Doctors’ fees for care received during hospital stay
- Hospital fees deemed medically unnecessary
- Prescription medication and supplies
- X-rays
What is included in Medicare Part B?
- Outpatient medical services and mental health care
- Doctor’s office visits
- Annual wellness visits
- Clinical lab tests and some diagnostic tests, including X-rays, MRIs, and CT scans
- Preventive care and services (like flu shots and mammograms)
- Home health visits and durable medical equipment for home
- Equipment or tests administered during outpatient services
- Medication administered during outpatient visits
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