When you first sign up for Medicare, you're actually enrolling in two distinct programs: Part A (Hospital Insurance) and Part B (Medical Insurance). Together they form "Original Medicare" — and understanding exactly what each part covers, what it costs, and where the gaps are is the foundation of smart Medicare planning in 2026.
Medicare Part A: Hospital Insurance
Part A is your hospital insurance. It kicks in when you're admitted as an inpatient to a hospital, skilled nursing facility, or other qualifying care setting. It also covers hospice care and limited home health services.
What Part A Covers
Inpatient Hospital Care
Covers a semi-private room, meals, nursing care, hospital-administered medications, operating room, diagnostic tests, and other hospital services during an inpatient stay. Does NOT cover private rooms (unless medically necessary) or private-duty nursing.
Skilled Nursing Facility (SNF) Care
Covers skilled nursing or rehabilitation services in a certified SNF after a qualifying hospital stay of 3+ consecutive days. Must begin within 30 days of discharge. Covers semi-private room, meals, skilled nursing, physical/occupational therapy, and medications administered at the facility.
Hospice Care
Covers comfort care for terminally ill patients expected to live 6 months or less. Includes nursing care, medications for symptom relief, counseling, and inpatient respite care. You must agree to forego curative treatment for the terminal condition.
Home Health Care
Covers part-time or intermittent skilled nursing care and physical/occupational/speech therapy at home when you're homebound and a doctor certifies you need it. Does NOT cover 24/7 home health aide services or custodial (non-medical) care.
Part A Costs in 2026
Part A uses a "benefit period" cost structure — unlike Part B's annual deductible, Part A resets every time you go 60 consecutive days without inpatient care.
Part A Premium
$0/month for most people (40+ quarters Medicare taxes)
$278/month for 30–39 quarters
$505/month for fewer than 30 quarters
Hospital Deductible
$1,676 per benefit period — this is what you pay for the first day of each hospital admission, not per calendar year. If you're hospitalized twice in a year (with 60+ days gap), you pay this twice.
Coinsurance for Long Stays
Days 1–60: $0 (covered by deductible)
Days 61–90: $419/day
Days 91–150: $838/day (lifetime reserve days)
Day 151+: You pay 100%
Medicare Part B: Medical Insurance
Part B covers the outpatient side of your healthcare — everything from annual physicals to specialist consultations, lab work, imaging, and medical equipment. Part B is where the majority of your day-to-day medical care happens.
What Part B Covers
Doctor & Outpatient Services
Covers visits to any Medicare-accepting doctor (primary care, specialists, surgeons), outpatient surgery, emergency room visits (when not admitted), urgent care, and second opinions.
Preventive Care (Often Free)
Many preventive services are covered at no cost to you: annual wellness visits, flu/pneumonia/COVID vaccines, cancer screenings (mammograms, colonoscopies, prostate cancer screening), cardiovascular disease screenings, diabetes screenings, depression screenings.
Diagnostic Tests & Lab Work
Blood tests, urinalysis, EKGs, X-rays, MRIs, CT scans, and other diagnostic imaging ordered by your doctor are covered under Part B. You typically pay 20% of the Medicare-approved amount after your deductible.
Durable Medical Equipment (DME)
Covers medically necessary equipment for home use: wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, blood glucose monitors, and more. Must be prescribed by a doctor and purchased from a Medicare-approved supplier.
Mental Health Services
Covers outpatient mental health care including psychotherapy, counseling, and psychiatric services. In 2026, licensed professional counselors and marriage and family therapists are covered at the same 20% coinsurance as other outpatient services.
Telehealth
Telehealth services are now permanently covered by Part B, including video visits for primary care, specialty consultations, and mental health services. You pay the same 20% coinsurance as in-person visits.
Part B Costs in 2026
Part B Premium
$185/month standard (income under $106,000/individual)
Higher earners pay IRMAA surcharges ranging from $259/month to $594/month depending on income tier.
Annual Deductible
$240/year — once you meet this, Medicare pays 80% of approved amounts for covered services. The deductible resets every January 1.
Coinsurance
20% of the Medicare-approved amount for most covered services after your deductible. There is NO out-of-pocket maximum in Original Medicare — this is why many people add Medigap.
What Parts A and B Do NOT Cover
This is equally important to understand. Original Medicare has significant coverage gaps:
- Routine Dental: No coverage for cleanings, fillings, dentures, or implants. A few procedures (tooth extraction before radiation therapy) may be covered as medically necessary.
- Routine Vision: No coverage for eye exams, glasses, or contact lenses. Cataract surgery is covered under Part B (but not eyeglasses except one pair post-cataract surgery).
- Hearing Aids: No coverage for hearing aids or exams to fit them. Diagnostic hearing tests by a doctor are covered under Part B.
- Long-Term Care: No coverage for custodial care (help with daily activities like bathing, dressing) in nursing homes or at home. This requires long-term care insurance or Medicaid.
- Most Prescription Drugs: Outpatient prescription drugs taken at home are not covered by Parts A or B. You need a separate Part D plan or a Medicare Advantage plan that includes drug coverage.
- Cosmetic Surgery: Not covered unless required due to accidental injury or to improve the functioning of a malformed body part.
- Routine Foot Care: Most routine podiatry services are not covered, though diabetic foot care may qualify under certain conditions.
When Both Part A and Part B Apply Simultaneously
During a hospital inpatient stay, both parts can be billed at the same time:
- The hospital facility charges (room, nursing staff, hospital medications) → billed to Part A
- Your physician's professional fees (the surgeon, anesthesiologist, your attending doctor) → billed to Part B
- Outpatient services ordered during your stay → may be billed to Part B
This means you could owe the Part A deductible ($1,676) AND Part B coinsurance (20% of physician charges) for the same hospitalization. On a complex surgery, this dual billing can add up quickly — another reason to consider Medigap coverage.
Part A vs Part B: Side-by-Side Comparison
Part A at a Glance
- Premium: $0 for most people
- Deductible: $1,676/benefit period
- Covers: Hospital, SNF, hospice, some home health
- Coinsurance kicks in after day 60 in hospital
- No annual reset — based on benefit periods
Part B at a Glance
- Premium: $185/month standard
- Deductible: $240/year
- Covers: Outpatient, doctors, labs, DME, preventive
- Coinsurance: 20% of approved amount
- Resets every January 1
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