Medicare Parts A & B: The Foundation of Your Coverage
Before you can choose a Medicare Advantage plan or a Supplement, you need to understand what Original Medicare actually covers — and where it leaves gaps. Here's a plain-English breakdown.
What Is Original Medicare?
Original Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). It has two core parts: Part A covers hospital and inpatient care; Part B covers outpatient services, doctor visits, and preventive care. Together, they form the foundation that every other Medicare coverage option — Advantage plans, Supplement plans, and Part D — is built on top of.
Most people get Part A premium-free if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). Part B always has a monthly premium.
Medicare Part A — Hospital Insurance
What it covers
- Inpatient hospital stays (semi-private room, meals, nursing care)
- Skilled nursing facility (SNF) care after a qualifying hospital stay
- Home health care (medically necessary, part-time or intermittent)
- Hospice care for terminal illness
- Inpatient care in a religious nonmedical health care institution
What it does NOT cover
- Custodial or long-term care (help with daily activities)
- Private-duty nursing
- Private room (unless medically necessary)
- Personal care items (TV, phone, toiletries)
2026 Costs
Medicare Part B — Medical Insurance
What it covers
- Doctor visits and outpatient services
- Preventive services (annual wellness visit, screenings, vaccines)
- Durable medical equipment (wheelchairs, walkers, oxygen)
- Outpatient mental health services
- Ambulance services
- Clinical research and second surgical opinions
- Outpatient surgery and observation services
What it does NOT cover
- Prescription drugs (covered by Part D or Advantage plans)
- Routine dental, vision, and hearing
- Acupuncture (except for chronic low back pain)
- Cosmetic surgery
- Care outside the U.S. (with limited exceptions)
2026 Costs
The Gaps in Original Medicare
Original Medicare covers a lot — but it leaves significant financial exposure. Understanding these gaps is the first step to choosing the right supplemental coverage.
No out-of-pocket maximum
Original Medicare has no cap on what you can spend in a year. A serious illness could cost tens of thousands of dollars.
20% coinsurance with no limit
Part B pays 80% of approved costs. You pay the remaining 20% — with no ceiling. A $100,000 surgery leaves you with a $20,000 bill.
No prescription drug coverage
Parts A and B don't cover most outpatient prescription drugs. You need Part D or a Medicare Advantage plan with drug coverage.
No routine dental, vision, or hearing
Original Medicare doesn't cover routine dental cleanings, eyeglasses, or hearing aids — three of the most common needs for Medicare-age adults.
Limited foreign travel coverage
Original Medicare generally doesn't cover care outside the United States, with very limited exceptions.
A Medicare Supplement or Medicare Advantage plan can fill many of these gaps. Not sure which is right for you?
Compare your optionsWhen to Enroll in Parts A & B
Initial Enrollment Period (IEP)
7-month window: 3 months before, the month of, and 3 months after your 65th birthday
Special Enrollment Period (SEP)
If you have employer coverage through active employment, you can delay Part B without penalty and enroll during an 8-month SEP after coverage ends
General Enrollment Period (GEP)
January 1 – March 31 each year, if you missed your IEP. Coverage starts July 1. Late enrollment penalties may apply.
Frequently Asked Questions
Questions About Parts A & B? Let's Talk.
Understanding Original Medicare is the foundation of every good Medicare decision. I help Northeast Florida residents navigate Parts A and B, choose the right supplemental coverage, and avoid costly enrollment mistakes — at no cost to you.