Understanding Original Medicare (Parts A & B)

The foundation of Medicare coverage that the federal government provides.


What is Original Medicare?


Original Medicare is the traditional fee-for-service program offered directly through the federal government. It consists of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Original Medicare provides a foundation of healthcare coverage for millions of Americans who are 65 or older, or those under 65 with certain disabilities or conditions.

When you enroll in Original Medicare, you can see any doctor or hospital in the United States that accepts Medicare. There's no need to select a primary care physician, and you typically don't need referrals to see specialists. This flexibility is one of the key advantages of Original Medicare.

However, it's important to understand that Original Medicare doesn't cover all healthcare expenses. You'll be responsible for deductibles, copayments, and coinsurance, and there's no annual out-of-pocket maximum to protect you from high costs. Additionally, Original Medicare doesn't include coverage for prescription drugs, dental care, vision, or hearing aids.

Medicare Part A:

Hospital Insurance


Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working for at least 10 years.

What Part A Covers:

  • Inpatient hospital care

  • Skilled nursing facility care (not custodial or long-term care)

  • Hospice care

  • Home health care

  • Inpatient care in a religious non-medical health care institution

What You Pay with Part A:

  • Deductible: $1,632 per benefit period (2025)

  • Hospital Stay:

  • Days 1-60: $0 coinsurance after deductible

  • Days 61-90: $408 coinsurance per day (2025)

  • Days 91 and beyond: $816 coinsurance per "lifetime reserve day" (up to 60 days over your lifetime)

  • Beyond lifetime reserve days: All costs

  • Skilled Nursing Facility Stay:

  • Days 1-20: $0 coinsurance

  • Days 21-100: $204 coinsurance per day (2025)

  • Days 101 and beyond: All costs

Note: These costs are for the year 2025 and may change annually.

Medicare Part B:

Medical Insurance


Medicare Part B covers medically necessary services and preventive services. This includes doctor visits, outpatient care, medical supplies, and preventive services. Most people pay a standard monthly premium for Part B.

What Part A Covers:

  • Doctor visits and services

  • Outpatient care

  • Preventative services (like flu shots and cancer screenings)

  • Clinical Research

  • Ambulance Services

  • Durable Medical Equipment (like wheelchairs and walkers)

  • Mental health services

  • Limited outpatient prescription drugs

What You Pay with Part B:

  • Monthly Premiums: $174.70 (2025 standard premium or higher depending on your income

    • IRMAA (Income-Related Monthly Adjustment Amount) affects the monthly premiums for Medicare Part B (medical insurance) and Part D (prescription drug coverage) for beneficiaries with incomes above certain thresholds

  • Annual Deductible: $240 (2025)

  • Coinsurance: Typically 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment

Note: These costs are for the year 2025 and may change annually.

Enrolling in Original Medicare


Most people become eligible for Medicare when they turn 65. If you're already receiving Social Security benefits, you'll be automatically enrolled in Medicare Parts A and B. If not, you'll need to sign up during your Initial Enrollment Period.


Initial Enrollment Period


Your Initial Enrollment Period is a 7-month period that includes:

• 3 months before the month you turn 65

• The month you turn 65

• 3 months after the month you turn 65


General Enrollment Period


If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period from January 1 to March 31 each year, with coverage starting July 1. However, you may face late enrollment penalties.


Special Enrollment Period


You may qualify for a Special Enrollment Period if you delayed Medicare enrollment because you had group health coverage through your or your spouse's current employment.

To enroll in Medicare, you can:

• Apply online at Social Security's website

• Call Social Security at 1-800-772-1213

• Visit your local Social Security office

What Original Medicare Doesn't Cover


While Original Medicare provides valuable coverage, it's important to understand its limitations. Here are some services and items that Original Medicare typically doesn't cover:

•Prescription drugs (outpatient)

•Dental care and dentures

•Vision exams and eyeglasses

•Hearing exams and hearing aids

•Long-term care (custodial care)

•Most care while traveling outside the U.S.

•Cosmetic surgery

•Acupuncture (with limited exceptions)

•Routine foot care

To get coverage for these services, you may need additional insurance such as a Medicare Advantage plan, a Medicare Part D prescription drug plan, or a Medicare Supplement (Medigap) policy.


Enhancing Your Original Medicare Coverage


Many people choose to enhance their Original Medicare coverage with additional insurance options:

Medicare Supplement Insurance (Medigap)

Medigap policies help pay some of the healthcare costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. These policies are sold by private insurance companies and can help make your healthcare costs more predictable.

Learn More About Medigap

Medicare Part D (Prescription Drug Coverage)

Since Original Medicare doesn't cover most prescription drugs, you may want to add a Medicare Part D plan. These plans are offered by private insurance companies approved by Medicare and help cover the cost of prescription medications.

Learn More About Part D

Medicare Advantage (Part C)

As an alternative to Original Medicare, you might consider a Medicare Advantage plan. These plans are offered by private insurance companies approved by Medicare and typically include all the benefits of Parts A and B, plus additional benefits like prescription drug coverage, dental, vision, and more.

Learn More About Medicare Advantage


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This is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/co-insurance may change on January 1 of each year. Medicare has neither reviewed nor endorsed this information.

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