Original Medicare: Parts A & B Explained

Learn how Original Medicare works, what Part A and Part B cover, what costs you may be responsible for, and what additional coverage options may help protect you from out-of-pocket expenses.

✔ Medicare Part A explained ✔ Medicare Part B explained ✔ Licensed Medicare guidance

Need Help Understanding Original Medicare?

Original Medicare can be confusing when you are first getting started. We can help explain how Part A and Part B work, what Medicare covers, what it does not cover, and whether a Medicare Advantage, Medicare Supplement, or Part D plan may fit your needs.

What Is Original Medicare?

Original Medicare is the federal health insurance program made up of Medicare Part A and Medicare Part B. It helps cover hospital care, doctor visits, outpatient services, preventive care, and certain medically necessary services.

Part A Hospital Insurance

Part B Medical Insurance

Federal Medicare Coverage

Nationwide Provider Access

Original Medicare is accepted by many doctors and hospitals nationwide, but it does not cover everything. Many people add extra coverage to help with prescription drugs, deductibles, coinsurance, copayments, and other costs.

Original Medicare includes:

What Does Medicare Part A Cover?

Medicare Part A is often called hospital insurance. It helps cover certain inpatient and facility-based care.

Inpatient Hospital Care

Part A helps cover medically necessary inpatient hospital stays after you are formally admitted to the hospital.

Skilled Nursing Facility Care

Part A may help cover skilled nursing facility care after a qualifying hospital stay, when Medicare rules are met.

Hospice Care

Part A helps cover hospice care for people who meet Medicare’s hospice eligibility requirements.

Some Home Health Care

Part A may help cover certain home health services when they are medically necessary and Medicare requirements are met.

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes long enough while working.

What Does Medicare Part B Cover?

Medicare Part B is often called medical insurance. It helps cover doctor visits, outpatient care, preventive services, and medically necessary services.

Doctor Visits

Part B helps cover visits with doctors, specialists, and other Medicare-approved healthcare providers.

Outpatient Care

Part B may help cover outpatient procedures, lab work, diagnostic tests, imaging, and other medical services.

Preventive Services

Part B helps cover many preventive services, screenings, wellness visits, and vaccines when Medicare rules are met.

Durable Medical Equipment

Part B may help cover certain medically necessary equipment, such as walkers, wheelchairs, or oxygen equipment.

Ambulance Services

Part B may help cover medically necessary ambulance transportation in certain situations.

Mental Health Services

Part B helps cover certain outpatient mental health services from Medicare-approved providers.

What Original Medicare Does Not Fully Cover

Original Medicare can provide strong basic coverage, but it may still leave you responsible for certain costs and services.

Most Prescription Drugs

Original Medicare usually does not cover most outpatient prescription drugs. Many people add a separate Part D plan.

Deductibles & Coinsurance

You may still be responsible for deductibles, coinsurance, and other out-of-pocket costs.

Routine Dental

Original Medicare generally does not cover routine dental exams, cleanings, fillings, dentures, or most dental procedures.

Routine Vision

Original Medicare generally does not cover routine eye exams, eyeglasses, or contact lenses in most cases.

Routine Hearing

Original Medicare generally does not cover routine hearing exams or hearing aids.

Long-Term Custodial Care

Original Medicare generally does not cover long-term custodial care, such as help with daily living activities.

What Costs Can Come With Original Medicare?

Even with Medicare Parts A and B, you may still have costs to plan for.

Cost Type	What It Means	Why It Matters
Part A Deductible	The amount you may pay for a hospital benefit period before Medicare pays.	Hospital stays can create significant out-of-pocket exposure.
Part B Premium	The monthly amount most people pay for Medicare Part B.	You usually need Part B to enroll in many additional Medicare coverage options.
Part B Deductible	The amount you pay before Part B starts paying for covered services.	This applies before Medicare begins sharing certain outpatient costs.
Coinsurance	Your share of costs after Medicare pays its portion.	Original Medicare usually leaves you responsible for a percentage of approved costs.
No Built-In Out-of-Pocket Maximum	Original Medicare does not have the same type of annual maximum out-of-pocket limit that many plans include.	This is one reason many people consider extra coverage.

Do You Need Coverage Beyond Original Medicare?

Many people keep Original Medicare and add coverage, while others choose a Medicare Advantage plan instead. The best choice depends on your doctors, prescriptions, budget, travel needs, and comfort with networks.

Medicare Supplement

Helps pay certain out-of-pocket costs that Original Medicare does not fully cover, such as deductibles, coinsurance, and copayments.

Medicare Part D

Helps cover outpatient prescription drugs. Part D plans vary by medications, pharmacies, premiums, and formularies.

Medicare Advantage

An alternative way to receive Medicare benefits through a private plan. Some plans may include extra benefits and drug coverage.

You may want extra coverage if you want help with:

When Should You Sign Up for Medicare Parts A & B?

Your Medicare Timing Matters

Many people first become eligible for Medicare around age 65. Your timing can depend on whether you are already receiving Social Security, whether you are still working, and whether you have employer coverage.

Initial Enrollment Period when you first become eligible
Special Enrollment Period if you delayed Part B because of qualifying employer coverage
General Enrollment Period if you missed your first chance to enroll
Late enrollment penalties may apply in some situations

If you are turning 65 soon, losing employer coverage, or unsure whether you need Part B, speak with a licensed agent before making a decision.

Original Medicare vs Medicare Advantage

Original Medicare and Medicare Advantage are two different ways to receive Medicare coverage.

Feature	Original Medicare	Medicare Advantage
Provided By	Federal government	Private insurance companies approved by Medicare
Includes	Part A and Part B	Part A and Part B benefits through a private plan
Doctor Access	Any provider that accepts Medicare	Often network-based, depending on plan type
Prescription Drug Coverage	Usually requires a separate Part D plan	Often included in many plans
Extra Benefits	Usually limited	May include dental, vision, hearing, fitness, OTC, or transportation

Why Work With Medicare Plan Assistance?

Clear Medicare Education

We explain Medicare Part A, Part B, Part D, Medicare Advantage, and Medicare Supplement options in plain language.

Coverage Gap Review

We help you understand what Original Medicare covers and where additional coverage may help reduce risk.

Enrollment Timing Support

We help you think through important timing questions, including turning 65, losing employer coverage, and Part B enrollment.

Simple, No-Pressure Guidance

No cost. No obligation. Just straightforward Medicare help from a licensed agent.

Have Questions About Original Medicare?

Get help understanding Part A, Part B, enrollment timing, prescription coverage, and additional plan options.

Speak With a Licensed Medicare Agent Today

Have questions about Medicare enrollment, plan options, costs, or benefits? Our licensed Medicare agents are here to help you understand your options and compare plans that may fit your healthcare needs and budget.

Whether you’re turning 65, reviewing your current coverage, moving to a new plan, or exploring savings programs, we’re here to provide simple, no-pressure guidance.

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Frequently Asked Questions

What is Original Medicare?

Original Medicare is the federal Medicare program made up of Part A and Part B. Part A helps cover hospital-related care, and Part B helps cover doctor visits, outpatient services, preventive care, and medically necessary services.

What is Medicare Part A?

Medicare Part A is hospital insurance. It helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care when Medicare requirements are met.

What is Medicare Part B?

Medicare Part B is medical insurance. It helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and certain medically necessary services.

Does Original Medicare cover prescription drugs?

Original Medicare usually does not cover most outpatient prescription drugs. Many people enroll in a separate Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage.

Does Original Medicare cover dental, vision, or hearing?

Original Medicare generally does not cover routine dental, vision, or hearing benefits. Some people consider Medicare Advantage or separate dental, vision, and hearing coverage for those needs.

Do I need Medicare Supplement or Medicare Advantage if I have Original Medicare?

It depends on your needs. Original Medicare may leave you responsible for deductibles, coinsurance, prescription drug costs, and other services. A licensed agent can help you compare whether Medicare Supplement, Part D, or Medicare Advantage may fit your situation.

Is there a fee to get help understanding Medicare?

No. There is no cost or obligation to speak with us about your Medicare questions and available options.

Related Medicare Resources

Medicare Advantage Plans

Medicare Supplement Plans

Medicare Part D Prescription Plans

Medicare Advantage vs Supplement

Lower Medicare Premiums

Long Term Care

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

We are not affiliated with or endorsed by Medicare, the federal government, or any specific insurance carrier. This is a solicitation for insurance. A licensed insurance agent may contact you. Plan availability varies by state, county, ZIP code, and carrier.