Original Medicare—administered directly by the federal government—is divided into two foundational pieces: Part A (Hospital Insurance) and Part B (Medical Insurance). Together, they form the core coverage framework for millions of beneficiaries.
However, Original Medicare is not an “all-expenses-paid” health plan. Navigating it successfully requires knowing what it covers, what it leaves out, and the exact out-of-pocket metrics you are responsible for paying.
Medicare Part A: Hospital Insurance
Medicare Part A primarily focuses on inpatient care. For the vast majority of Americans, Part A features a $0 monthly premium because they (or their spouse) paid Medicare taxes for at least 10 years (40 quarters) while working.
What Part A Covers
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Inpatient Hospital Care: Semi-private rooms, meals, general nursing, and medications administered as part of your inpatient treatment.
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Skilled Nursing Facility (SNF) Care: Short-term rehabilitation care following a qualified, 3-day inpatient hospital stay.
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Hospice Care: Palliative and supportive care for terminally ill beneficiaries.
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Home Health Services: Limited, medically necessary part-time skilled care if you are homebound.
What Part A Costs in 2026
Unlike typical health insurance plans that use an annual deductible, Part A utilizes a “benefit period” structure. A benefit period begins the day you are admitted as a hospital inpatient and ends when you have not received any inpatient hospital or skilled nursing care for 60 consecutive days. If you are admitted again after those 60 days, a brand-new benefit period starts, and you must pay the deductible again.
| Out-of-Pocket Cost Category | 2026 Financial Responsibility |
| Monthly Premium | $0 for most people. Up to $565 if you have fewer than 30 work quarters. |
| Inpatient Deductible | $1,736 per benefit period (covers your first 60 days). |
| Hospital Coinsurance (Days 61–90) | $434 per day. |
| Lifetime Reserve Days (Days 91–150) | $868 per day (you get 60 of these days max across your lifetime). |
| Skilled Nursing Facility Coinsurance | $0 for days 1–20; $217 per day for days 21–100. |
Medicare Part B: Medical Insurance
Medicare Part B handles outpatient medical necessity. Unlike Part A, everyone pays a monthly premium for Part B, which is typically deducted automatically from your Social Security benefit check.
What Part B Covers
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Doctor and Provider Services: Visits to primary care doctors, specialists, and outpatient procedures.
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Preventive Services: Annual wellness exams, flu shots, cardiovascular screenings, and many cancer screenings (often at $0 out-of-pocket cost to you).
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Durable Medical Equipment (DME): Wheelchairs, walkers, oxygen equipment, and blood sugar monitors.
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Outpatient Care: Mental health services, lab tests, X-rays, and emergency room visits.
What Part B Costs in 2026
Part B costs operate on a standard calendar year cycle. Once you meet your annual deductible, you are responsible for a fixed percentage of the cost of care.
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Standard Monthly Premium: $202.90.
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Annual Deductible: $283 per year.
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Coinsurance: 20% of the Medicare-approved amount for most covered doctor services and equipment.
Important Note for Higher Earners (IRMAA): If your Modified Adjusted Gross Income (MAGI) from your 2024 tax return was above $109,000 (filing individually) or $218,000 (jointly), you will pay an Income-Related Monthly Adjustment Amount (IRMAA) surcharge. This can push your total monthly Part B premium to anywhere between $284.10 and $689.90.
The Gaps: What Original Medicare Does Not Pay For
It is highly critical to understand that Original Medicare has no maximum out-of-pocket limit. If you incur massive medical bills under Part B’s 20% coinsurance framework, your out-of-pocket exposure is theoretically infinite.
Additionally, Parts A and B entirely exclude coverage for:
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Prescription Drugs: Self-administered, retail medications are not covered (you need a standalone Part D plan or a Medicare Advantage plan for this).
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Routine Dental Care & Dentures
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Routine Vision Exams & Eyeglasses
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Hearing Aids & Routine Hearing Exams
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Long-Term Custodial Care: Nursing home stays that only assist with activities of daily living (like bathing or dressing) rather than medical rehabilitation.
Protecting Yourself From Financial Gaps
Because of these gaps and the lack of a financial safety net limit, most enrollees do not rely solely on Original Medicare. They generally choose between two pathways:
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Option A: Pair Original Medicare (Parts A & B) with a standalone Part D prescription plan and a private Medicare Supplement (Medigap) policy, which steps in to pay your Part A and B deductibles and coinsurance costs.
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Option B: Opt out of Original Medicare delivery and enroll in a private Medicare Advantage plan (Part C), which bundles Parts A, B, and usually D into a single plan, often features dental/vision add-ons, and explicitly caps your annual out-of-pocket maximum exposure.
If you are evaluating these choices for your specific retirement roadmap, sharing your current status—such as whether you have retiree coverage or take regular medications—can help map out the most cost-effective path.