What is Original Medicare?
Original Medicare is the federal government's health insurance for people 65 and older (and some younger people with disabilities). It has two parts:
- Part A, Hospital insurance
- Part B, Medical insurance
Most people qualify automatically based on their (or their spouse's) work history of paying Medicare taxes. Original Medicare lets you see any doctor or hospital in the United States that accepts Medicare assignment, with no networks and no referrals required.
Part A: Hospital insurance
Part A helps cover inpatient hospital care, skilled nursing facility care (after a qualifying hospital stay), hospice care, and some home health services.
What Part A typically covers
- Inpatient hospital stays (semi-private room, meals, general nursing, drugs given as part of inpatient treatment)
- Skilled nursing facility care following a qualifying hospital stay
- Hospice care for people with a terminal illness
- Limited home health care
What Part A costs
Most people pay no monthly premium for Part A, if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) of work, Part A is premium-free.
Even with premium-free Part A, you still pay a deductible for each benefit period, and coinsurance can apply for longer hospital stays or extended skilled nursing care. A benefit period starts the day you're admitted as an inpatient and ends after 60 consecutive days with no inpatient care, so multiple admissions in a year can mean multiple deductibles.
Part B: Medical insurance
Part B covers the outpatient and physician side of medicine, the things you use most often.
What Part B typically covers
- Doctor visits, specialist visits, and second opinions
- Outpatient surgeries and procedures
- Lab work, X-rays, and other diagnostic testing
- Durable medical equipment (wheelchairs, walkers, oxygen, CPAP, etc.)
- Preventive services (annual wellness visit, screenings, most vaccines)
- Mental health services
- Some home health care
- A limited set of drugs administered in a clinical setting
What Part B costs
Part B has a monthly premium set by CMS each year. Most people pay the standard premium; higher-income beneficiaries pay more under IRMAA rules, based on income reported on the tax return from two years ago.
After meeting the annual Part B deductible, you typically pay 20% coinsurance for most Medicare-covered services, with Medicare paying the other 80%. There is no annual out-of-pocket maximum with Original Medicare alone.
See our Medicare costs guide for current premium, deductible, and coinsurance figures.
What Original Medicare does NOT cover
Even with both Part A and Part B, there are real gaps:
- Most prescription drugs: you need Part D or a Medicare Advantage plan with drug coverage
- Routine dental, vision, and hearing: including eyeglasses, dentures, and most hearing aids
- Long-term care (custodial care in a nursing home or assisted living)
- Health care outside the U.S. in most cases
- An out-of-pocket maximum: your costs can keep adding up without a cap
Filling the gaps: your two main paths
Most people pair Original Medicare with one of these two routes:
- Medicare Advantage (Part C) , replaces Original Medicare with an all-in-one private plan that has its own networks, copays, and an annual out-of-pocket maximum. Often includes Part D and extras like dental and vision.
- Medicare Supplement (Medigap) , keeps Original Medicare in place and adds a private policy that helps pay your deductibles, coinsurance, and copays. Most people pair this with a separate Part D drug plan.
Both routes have trade-offs. See our comparison of both routes for help deciding which one fits your priorities.