When people refer to Original Medicare, they are talking about Part A (Hospital Insurance) and Part B (Medical Insurance). These two parts are administered directly by the federal government and form the foundation of Medicare coverage. Understanding what each part covers, and what it does not cover, is essential.

Medicare Part A – Hospital Insurance
Medicare Part A primarily covers inpatient and facility-based care.

What Part A Covers:

• Inpatient hospital stays
• Skilled nursing facility (SNF) care following a qualifying hospital stay
• Hospice care
• Limited home health care when medically necessary

How Costs Work Under Part A:

Premium: Most people do not pay a monthly premium for Part A if they (or their spouse) worked and paid Medicare taxes long enough.

Deductible: Part A has a per-benefit-period deductible, not an annual deductible.

A Benefit Period begins the day you are admitted as an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days.

Hospital Coinsurance Structure:

• Days 1–60: After the deductible, Medicare typically covers 100%.
• Days 61–90: A daily coinsurance amount applies.
• Days 91–150: A higher daily coinsurance applies (lifetime reserve days).
• Beyond 150 days: You are generally responsible for all costs.
  Skilled Nursing Facility Coinsurance Structure:
• Days 1–20: Typically covered in full.
• Days 21–100: Daily coinsurance applies.
• After day 100: You are responsible for all costs.

Important Limitations of Part A:
Does not cover long-term custodial care.
Coverage is based on medical necessity and qualifying criteria.

Medicare Part B – Medical Insurance
Medicare Part B covers outpatient and medically necessary services.

What Part B Covers:

• Doctor visits (primary care and specialists)
• Outpatient surgeries
• Lab work and diagnostic testing
• Preventive services (many covered at 100%)
• Durable medical equipment
• Physical therapy and certain home health services

How Costs Work Under Part B:
Premium: Most people pay a monthly premium for Part B. Higher-income individuals may pay more.

Annual Deductible: Part B has a yearly deductible.

Coinsurance: After the deductible is met, Medicare typically pays 80% of approved charges. You are responsible for the remaining 20% coinsurance, and there is no annual out-of-pocket maximum under Original Medicare.

Important Limitations of Part B:
If a provider does not accept Medicare assignment, you may owe more. There is no cap on the 20% coinsurance. Routine dental, vision, and hearing services are generally not covered.

The Gaps in Original Medicare
Original Medicare leaves several out-of-pocket exposures, including hospital deductibles, daily hospital and skilled nursing coinsurance, 20% Part B coinsurance (with no cap), and no routine prescription drug coverage.

How Most People Supplement Original Medicare
Because of these gaps, many beneficiaries choose to add additional coverage.

Medicare Supplemental (Medigap) Plans
A Medicare supplemental plan, also known as a Medigap plan, is sold by private insurance companies and works alongside Original Medicare. These plans help pay some or most of the deductibles, copays, and coinsurance left behind by Part A and Part B and allow you to keep Original Medicare as your primary insurance.

Medicare Part D – Prescription Drug Coverage
Original Medicare does not cover most outpatient prescription medications. Most people enroll in a stand-alone Medicare Part D plan, which is offered by private insurance companies and has its own premium, deductible, and cost-sharing structure.

Summary
Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). There is no out-of-pocket maximum, deductibles and coinsurance apply, and prescription drugs are not included. Many individuals pair Original Medicare with a Medicare supplemental (Medigap) plan and a Part D plan for prescription drug coverage.

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