Original Medicare resource center

Original Medicare: Parts A and B Made Clear

Understand what Medicare Part A and Part B cover, what Original Medicare leaves to you, and which hospital, skilled nursing, home health, hospice and equipment rules deserve a closer look.

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Quick answer: Original Medicare is the federal health insurance program made up of Part A and Part B. Part A primarily covers inpatient hospital, skilled nursing facility, hospice and certain home health care. Part B primarily covers physicians, outpatient care, preventive services, durable medical equipment and certain home health care. Original Medicare does not include routine outpatient drug coverage or an annual out-of-pocket maximum.

The two parts

How Part A and Part B divide coverage

Part A: hospital insurance

Part A helps cover inpatient hospital care after a formal admission, limited care in a skilled nursing facility after a qualifying hospital stay, hospice care and certain home health services. It is not a blanket long-term-care benefit.

Review Part A coverage and 2026 costs →

Part B: medical insurance

Part B helps cover physicians, outpatient services, preventive care, laboratory testing, ambulance services, durable medical equipment and certain home health services. Medical necessity, frequency and supplier rules still apply.

Review Part B coverage and 2026 costs →

If kidney failure is the issue, use the separate Medicare and ESRD guide for dialysis, transplant and ESRD-specific coordination rules. For diabetes, see Medicare Diabetes Coverage for the Part B-versus-Part D split across CGMs, pumps, insulin and testing supplies. For therapy, psychiatry and telehealth, use the separate Medicare Mental Health Coverage guide. For ground, air and scheduled transport rules, see Medicare Ambulance Coverage.

2026 costs

What can you pay under Original Medicare?

In 2026, the standard Part B premium is $202.90 per month and the annual Part B deductible is $283. After that deductible, a beneficiary commonly pays 20% of the Medicare-approved amount for covered Part B services when the provider accepts assignment.

The 2026 Part A inpatient hospital deductible is $1,736 for each benefit period, not once per calendar year. Hospital and skilled nursing coinsurance can apply as a covered stay continues. Most people do not pay a Part A premium because they or a spouse earned at least 40 quarters of Medicare-covered work. See how the 40-credit rule works and what happens with fewer credits →

Original Medicare has no annual out-of-pocket limit. Without other coverage, there is no calendar-year ceiling on deductibles and coinsurance for Part A and Part B services. That is one reason people compare a Medicare Supplement or compare Original Medicare with Medicare Advantage.

Provider access

Can you use any doctor or hospital?

You can generally use any doctor or hospital in the United States that accepts Medicare and is willing to treat you. Original Medicare does not use an HMO or PPO network. That flexibility does not mean every provider must accept every patient, and it does not guarantee that every item or service is covered.

Accepts assignment

The provider agrees to accept the Medicare-approved amount as full payment for a covered service. You remain responsible for the applicable deductible and coinsurance.

Does not accept assignment

A participating situation can involve different payment timing and, for some Part B services, a limiting charge above the Medicare-approved amount. Ask before care whenever possible.

Hospital status

An overnight hospital stay is not always inpatient care

Medicare treats you as an inpatient only after a doctor formally orders inpatient admission and the hospital admits you. You can remain in a hospital overnight while classified as an outpatient receiving observation services. That classification can change which part of Medicare pays and whether the stay counts toward the usual three-day inpatient requirement for later skilled nursing facility coverage.

Learn how inpatient, outpatient and observation status affect Medicare costs →

Coverage boundaries

What Original Medicare does not automatically cover

Most outpatient prescription drugs; a separate Part D plan is usually needed.
Most long-term custodial care in a nursing home, assisted living setting or private home.
Routine dental care, most routine eye examinations, eyeglasses in most situations and hearing aids.
Routine physical examinations that are different from Medicare’s covered preventive visits.
Most health care outside the United States, except limited statutory situations.

Coverage can turn on why a service is performed, the setting, the provider’s documentation and whether Medicare considers it medically necessary. A preventive service can have no patient cost while related diagnostic work during the same encounter has ordinary Part B cost sharing.

Reading the record

Use the Medicare Summary Notice to verify claims

Original Medicare mails or electronically provides a Medicare Summary Notice for Part A and Part B claims. It is not a bill. Use it to confirm the service, the Medicare-approved amount, what Medicare paid, what the provider may bill and whether a claim was denied. If something looks wrong, compare it with the provider bill and follow the appeal instructions and deadline printed on the notice.

For a problem with payment or coverage, continue to Medicare Claims, Denials and Appeals.

Frequently asked questions

Original Medicare Questions

Is Original Medicare the same as Medicare Advantage?

No. Original Medicare is administered by the federal government. Medicare Advantage is an alternative way to receive Part A and Part B benefits through a private Medicare-approved plan, subject to the plan’s network and coverage rules.

Does Original Medicare include prescription coverage?

It covers limited drugs in defined Part A or Part B situations, but it does not provide broad retail outpatient prescription coverage. Most people using Original Medicare add a standalone Part D plan.

Do I need both Part A and Part B?

The answer depends on current employment coverage, enrollment rules and the coverage path you want. Most people using Original Medicare or Medicare Advantage need both, but delaying Part B can be appropriate in some employer-coverage situations.

Does Original Medicare have a provider network?

No HMO or PPO network applies. You may generally use any U.S. provider that accepts Medicare and agrees to treat you.

Does Original Medicare cover long-term nursing-home care?

It may cover limited skilled nursing facility care when all requirements are met. It does not cover most custodial long-term care.

More Medicare guidance

Primary references

Official Sources

Reviewed against official sources on August 22, 2026. Medicare and state program rules can change; verify current requirements before acting.

Independent Medicare guidance

Make the Next Decision With the Actual Details in Front of You

Benjamin Thompson can help compare the Medicare insurance options represented by Thompson Medicare Brokerage using your doctors, prescriptions, coverage priorities and budget.