Part A: Hospital insurance
Generally helps cover inpatient hospital care, skilled nursing facility care, hospice, and some home health care.
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Original Medicare is the federal health insurance program that includes Part A and Part B. Understanding what each part does—and what it does not cover—is a useful first step.
Part B: Medical insurance
Generally helps cover doctor visits, outpatient care, preventive services, and medically necessary supplies.
Understand the gaps
Original Medicare does not cover everything. You may want to consider prescription coverage and ways to manage out-of-pocket costs.
Know when to enroll
Enrollment timing can affect your coverage and costs. We can help you understand the periods that apply to your situation.
A closer look
The details worth understanding
What Parts A and B actually cover
Part A generally covers inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice, and some home health care. Part B generally covers outpatient services, doctor visits, preventive care, and durable medical equipment. Coverage depends on Medicare’s rules for each service.
Your costs go beyond the premium
Original Medicare has deductibles and cost sharing. Part B typically has a monthly premium and, after its deductible, generally pays 80% of the Medicare-approved amount for covered services; you generally pay the remaining 20%. Part A costs depend on the type and length of care.
When to sign up
Most people first qualify at 65. Your Initial Enrollment Period usually runs for seven months: three months before your 65th birthday month, that month, and three months after. Some people qualify for a Special Enrollment Period when qualifying employer coverage ends.
- If you receive Social Security benefits before 65, you may be enrolled automatically.
- Late enrollment can mean a coverage gap or a lasting Part B penalty if you do not qualify for an exception.
What Original Medicare does not include
Original Medicare usually does not cover routine dental, vision, or hearing care, and it does not include most outpatient prescription drugs. It also has no annual out-of-pocket maximum for covered Part A and Part B services. A separate Part D plan or other coverage may help address some of these gaps.
Where supplements fit
If you keep Original Medicare, a Medicare Supplement (Medigap) policy can help with certain deductibles and coinsurance. Another route is Medicare Advantage (Part C), which provides your Part A and B benefits through a private plan. The two approaches work differently and cannot be used together.
A simple first checklist
Before choosing additional coverage, confirm when your Parts A and B start, list your prescriptions and preferred doctors, and estimate your budget for premiums and out-of-pocket costs. We can help you compare the paths that fit your circumstances.
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Common questions
Good questions deserve clear answers.
Every situation is different. These answers are a starting point, and we’re happy to talk through yours.
Is Original Medicare the same as Medicare Advantage?
No. Original Medicare is Part A and Part B administered by the federal government. Medicare Advantage (Part C) is an alternative way to receive Part A and B benefits through a private plan approved by Medicare.
Does Original Medicare cover prescriptions?
It covers a limited number of medications in specific settings, but not most prescriptions you pick up at a pharmacy. For those, you may need a separate Part D plan or other creditable drug coverage.
Can I see any doctor with Original Medicare?
You can generally see any doctor or hospital in the U.S. that accepts Medicare. Confirm that the provider accepts Medicare and ask whether they accept assignment, which can affect your costs.
Do I have to enroll at 65 if I am still working?
It depends on your existing coverage and your employer’s size. Some people with qualifying employer group coverage can delay Part B without penalty, but the rules are specific. Check with your benefits administrator and Social Security before delaying enrollment.
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