What is Original Medicare (Part A and Part B)?
Original Medicare (also called traditional Medicare) is individual insurance provided by the federal government. It includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Part A
Helps pay for hospital stays and inpatient care
Part B
Helps pay for doctor visits and outpatient care
Who is eligible for Original Medicare?
You may become eligible to receive Medicare benefits based on any one of the following:
- You are age 65 or older
- You are younger than 65 with a qualifying disability (Medicare eligibility begins after 24 months of receiving Social Security disability benefits)
- You have a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease) at any age
You must be a U.S. citizen and legal resident. Legal residents must live in the United States for at least 5 years in a row, including the 5 years just before applying for Medicare.
What does Medicare Part A cover?
Medicare Part A covers the hospital charges and most of the services you receive when you're in the hospital.
Hospital stays and inpatient care, including:
- A semi-private room
- Hospital meals
- Skilled nursing services
- Care in special units, like intensive care
- Drugs, medical supplies and medical equipment used during an inpatient stay
- Lab tests, X-rays and medical equipment used as an inpatient
- Operating room and recovery room services
- Some blood transfusions in a hospital or skilled nursing facility
- Inpatient or outpatient rehabilitation services after a qualified inpatient stay
- Part-time, skilled care for the homebound
- Hospice care for the terminally ill, including medication to manage symptoms and control pain
What is not covered by Medicare Part A?
- Personal expenses while hospitalized, like a TV or phone service
- Most care outside of the United States
- Custodial care (care that helps with daily life activities, like eating and bathing)
- Long-term care
- Days spent in a psychiatric hospital beyond certain set limits
- Hospital stays beyond certain set limits
How much does Medicare Part A cost?
Medicare Part A is free for most people. You do not have to pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years. Part A does charge a deductible and copays. Part A deductibles are charged per benefit period. A benefit period begins the day you are admitted to the hospital and ends when you’ve been out of the hospital 60 days in a row.
You pay one deductible even if you have more than one hospital stay during a single benefit period. Below you'll see the different Medicare Part A costs that may apply. Costs are shown for 2025.
Part A premium
For most people: $0
If applicable: Up to $518 per month in 2025
Part A deductible
Per benefit period: $1,676 in 2025
Part A copayment
Inpatient hospital stay
Days 1–60: $0 after you pay your Part A deductible
Days 61–90: $419 per day in 2025
Days 91 and beyond: $838 per day up to 60 lifetime reserve days*in 2025
Skilled nursing facility stay (per benefit period)
Days 1–20: $0
Days 21–100: $209.50 per day in 2025
Days 101 and beyond: You pay all costs
Home health care
$0 for covered home health care services
20% of the Medicare-approved amount for durable medical equipment
Hospice care
$0 for covered hospice care services
You may also pay:
Up to a $5 copayment for each prescription drug and other similar products for pain relief and symptom control while you're at home
5% of the Medicare-approved amount for inpatient respite care
*Lifetime reserve days are a set number of covered hospital days you can draw on if you’re in the hospital longer than 90 days. You have 60. Each lifetime reserve day may be used only once, but you may apply the days to different benefit periods. Lifetime reserve days may not be used to extend coverage in a skilled nursing facility.
What is Medicare Part B?
Medicare Part B (medical insurance) is the other half of Original Medicare. Part B covers care you receive in a clinic or hospital as an outpatient including most doctor services you receive as an inpatient, doctor visits, most routine and emergency medical services and some preventive care. The list below shows examples of some of the items and services Part B covers.
Note: Generally, Medicare Part B is not required. You can choose to opt out and only enroll in Part A, but you may need to enroll in both Part A and Part B to qualify for other coverage, such as a Medicare Advantage plan.
What does Medicare Part B cover?
Medicare Part B covers doctor visits and most routine and emergency medical services. It also covers some preventive care, like flu shots.
- Doctor visits, including when you are in the hospital
- An annual wellness visit and preventive services, like flu shots and mammograms
- Outpatient medical services
- Clinical laboratory services, like blood and urine tests
- X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
- Some health programs, like smoking cessation, obesity counseling and cardiac rehab
- Clinical laboratory services
- Physical therapy, occupational therapy and speech-language pathology services
- Diabetes screenings, diabetes education and certain diabetes supplies
- Mental health care as an outpatient
- Durable medical equipment for use at home, like wheelchairs and walkers
- Ambulatory surgery center services
- Ambulance and emergency room services
- Skilled nursing care and health aide services for the homebound on a part-time or intermittent basis
What is not covered by Medicare Part B
- Eye exams, eyeglasses or contact lenses
- Hearing tests or hearing aids
- Dental exams, cleanings, X-rays or routine dental care
- Acupuncture
- Most prescription drugs
- Long-term care (also called custodial care)
- Cosmetic surgery
- Routine foot care
Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition.
How much does Medicare Part B cost?
Medicare Part B shares some costs with you when you see the doctor or use other medical services. Part B has a monthly premium that is either deducted from your monthly Social Security benefits check or that you pay directly to Medicare. The amount you pay can vary depending on your tax reported income from two years prior.
Below you'll see the different costs that may apply. Part B costs include a monthly premium, an annual deductible, and coinsurance for most services. Costs shown are for 2025.
Part B premium
Per month: $185 to $628.90 in 2025, depending on income
Part B deductible
Per year: $257 in 2025
Part B coinsurance
20% of the Medicare-approved amount for:
- Most medical services
- Durable medical equipment
- Outpatient mental health care
How Medicare Part B cost sharing works
You will pay the Medicare Part B premium and share part of costs with Medicare for covered Part B health care services. Medicare Part B pays 80% of the cost for most outpatient care and services, and you pay 20%.
For 2025, the standard monthly Part B premium is $185.
You'll pay the standard amount if:
- You enroll for the first time in 2025
- You aren't receiving Social Security benefits
- Your premiums are billed directly to you
- You have Medicare and Medicaid, and Medicaid pays your premiums
Your Part B premium may be less than the standard amount if you enrolled in Part B in 2023 or earlier and your premium payments are deducted from your Social Security check.
Your premium may be more than the standard amount based on your income. You will pay an income‑related monthly adjustment amount (IRMAA) if your reported income was above $106,000 for individuals or $212,000 for couples in 2025. Visit Medicare.gov to learn more about IRMAA.
And while Medicare will share your Part B health care costs with you, there is something called "Medicare assignment" that's important to understand.
Doctors and providers who accept Medicare assignment agree to take what Medicare pays—the Medicare-approved amount—as payment in full. Medicare reduces the approved amount it pays for doctors who don't accept Medicare assignment. Doctors who don't accept Medicare assignment may charge more than the Medicare-approved amount. You may have to pay the additional cost, which is called "excess charges."
Medicare Part B covers doctor visits, lab tests, preventive screenings and other outpatient health care services. Part B costs include a monthly premium, an annual deductible and coinsurance for most services.
Factors that may affect Original Medicare (Part A and Part B) costs
The costs associated with Medicare Part A and Part B depend on the health care needs of the individual. Outside of the coverage details listed above, additional factors that may impact the cost of Original Medicare include:
- Personal health care needs regarding the frequency of services
- The costs of services and supplies not covered by your Medicare plan(s)
- Choosing a health care provider that is in or out of network
- Whether you have Medicaid or a Medicare Supplement plan
- Whether you have an additional health insurance coverage that works with Medicare
How to enroll in Medicare Part A or Part B
There are two ways to get Medicare Part A and Part B.
The first is to only get Original Medicare (Part A and Part B), which covers the above items and services. You can choose to add additional coverage at an added cost for things like prescription drugs (Part D) or out-of-pocket costs (Medicare Supplement insurance). You get Original Medicare from the Social Security Administration.
The second option is to get a Medicare Advantage (Part C) plan that provides the Part A and Part B coverage as well as usually including Part D prescription drug coverage and extra benefits like vision, dental, hearing, and fitness. You get Medicare Advantage plans from private insurance companies approved by Medicare.
If you are receiving Social Security or Railroad Retirement Board benefits, you will be enrolled in Medicare automatically when you turn 65 and get your Medicare card in the mail. If you are not enrolled automatically, you will need to sign up by yourself. You can enroll in Medicare Part A and Part B online at www.ssa.gov, in person at your local Social Security office or by phone at 1-800-772-1213 (TTY 1-800-325-0778).
The Part A late enrollment penalty
If you must pay a Part A premium and enroll late, you could pay a penalty. The Part A late enrollment penalty is 10% of the Part A premium. You pay the penalty in addition to your Part A premium for twice the number of years you delay enrollment.
Example: If you delay 2 years, you will pay an additional 10% of the Part A premium for 4 years (2 x 2 years).
The Part B late enrollment penalty
The Part B penalty is 10% of the monthly premium amount for each full 12-month period enrollment is delayed. You pay the Part B premium penalty in addition to your Part B premium for as long as you have Medicare Part B.
Example: You delayed Part B 3 years. To calculate how much your penalty will cost, you'll multiply (10% of Part B premium) x (# of years enrollment is delayed). In this case, (10%) x (3). Thus, your Part B premium penalty will be 30% of the Part B premium.
What Original Medicare doesn't cover
Original Medicare doesn't cover everything. With a few exceptions, Original Medicare doesn't include coverage for prescription drugs. It also does not cover health care benefits you may have been used to getting with an employer plan such as dental, vision, hearing health care or wellness items like fitness memberships.
Learn more about getting prescription drug coverage
Learn how to get coverage for dental, vision and other benefits with Medicare
The following are some common health services and items not covered by Medicare Part A or Part B.
Original Medicare does not cover:
- Most care outside of the United States
- Personal expenses while hospitalized, such as a TV or phone
- Custodial care (care that helps with daily life activities like eating or bathing)
- Long-term care
- Days spent in a psychiatric hospital beyond certain set limits
- Hospital days beyond set limits
- Eye exams, eyeglasses or contact lenses
- Hearing exams or hearing aids
- Dental exams, cleanings, X-rays or routine dental care
- Most prescription drugs
- Wellness benefits such as gym memberships
Would I benefit from additional coverage?
Depending on your specific health care needs, a Medicare Advantage, Medicare Supplement insurance (Medigap) or Medicare Part D plan from a private insurer may help you meet health care coverage needs not met by Original Medicare.
Explore the differences between Original Medicare and Medicare Advantage plans
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