Original Medicare
Part A and Part B, explained simply
Original Medicare is the federal side of your coverage. Understanding what it pays, and what it leaves to you, is the foundation for every other decision.
Part A
Hospital insurance
What it covers
- Inpatient hospital care
- Skilled nursing facility care after a qualifying stay
- Hospice care
- Some home health care
What it costs
- Most people pay no monthly premium because of their work history.
- There is a deductible for each benefit period, not once a year.
- Longer stays add daily coinsurance amounts.
Part B
Medical insurance
What it covers
- Doctor and specialist visits
- Outpatient care and surgery
- Preventive services and screenings
- Durable medical equipment
- Lab work and diagnostic tests
What it costs
- There is a monthly premium, which can be higher at higher income levels.
- There is an annual deductible.
- After the deductible you generally pay coinsurance on the Medicare-approved amount.
Specific dollar figures are set by the federal government and change by year. Confirm the current amounts on Medicare.gov, or ask us for the current year figures during a review.
How it stacks
Where a Medicare Supplement fits
Read this top to bottom. Each layer is optional except the first.
Medicare Part A + Part B
Hospital and medical insurance from the federal government.
Original Medicare
Pays a large share of approved costs. No annual out-of-pocket maximum on its own.
Optional Medigap supplement
A private policy that helps pay certain Medicare-covered cost sharing.
Optional separate prescription coverage
Part D is a separate plan for prescription drugs.
Clearing things up
Common misunderstandings
Does Original Medicare have a network?
No. You can use any provider in the country that accepts Medicare. What matters is whether the provider accepts assignment.
Does Medicare cover 100% after the deductible?
No. Coinsurance and copayments continue after deductibles are met, and some services are not covered at all.
Is a supplement the same as Medicare Advantage?
No. A Medigap policy works alongside Original Medicare. Medicare Advantage is a different way to receive your Medicare benefits through a private plan, and you cannot use a Medigap policy with it.
Do I have to take Part B right away?
It depends on whether you have qualifying coverage from active employment. Delaying without qualifying coverage can create a late enrollment penalty and can affect when your Medigap Open Enrollment window opens.