Parts A and B
Original Medicare: Parts A and B
The federal program itself, before any private plan is added. Here is what it covers and where the gaps are.
Part A: hospital insurance
Inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice, and some home health care.
Most people pay no premium for Part A because they or a spouse paid Medicare taxes long enough while working. Part A still has a deductible for each benefit period.
Part B: medical insurance
Doctor visits, outpatient care, lab work, durable medical equipment, and preventive services.
Part B has a monthly premium and an annual deductible. After the deductible, you generally pay twenty percent of the Medicare-approved amount for most services, with no cap on that twenty percent.
What Original Medicare does not cover
- Most routine dental, vision, and hearing care
- Prescription drugs you take at home, which is what Part D is for
- Long-term custodial care
- Care outside the United States, in most situations
The gap that surprises people most is the missing out-of-pocket maximum. Original Medicare on its own does not put a ceiling on what a serious year could cost you.
How people close the gaps
Two common approaches, and you generally choose one:
- Add a Medicare Supplement (Medigap) policy and a separate Part D drug plan, keeping Original Medicare and its freedom to see any provider who accepts Medicare.
- Move to a Medicare Advantage plan, which caps your annual out-of-pocket spending but generally uses a network.
Official resource
Check the source, then ask for personal help
Educational information is general. A licensed agent can help with plan comparisons; agents do not provide medical, legal, or official eligibility advice.
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