Medicare 2026

Original Medicare Explained: What Parts A and B Cover

Original Medicare is the federal health insurance program most people picture when they hear "Medicare." It's made up of two parts — Part A and Part B — and it has been around since 1965. If you're getting oriented, understanding what each part does (and what it doesn't) is the best first step before you look at prescription drug coverage or any additional policy.

Part A: hospital insurance

Part A is the hospital side of Medicare. It helps pay for:

• Inpatient care in a hospital
• Skilled nursing facility care after a qualifying hospital stay
• Hospice care
• Some home health care

Most people don't pay a monthly premium for Part A because they (or a spouse) paid Medicare taxes while working. There are still cost-sharing pieces — a deductible when you're admitted to the hospital, and daily copayments if a stay runs long — but the biggest expense, the premium, is usually $0.

A few things to keep in mind. Skilled nursing coverage kicks in after a qualifying inpatient hospital stay, not any time you need rehab. Hospice is a specific benefit for people with a terminal illness and comes with its own rules. And "home health care" under Medicare is narrower than many people assume — it generally applies when you're homebound and need skilled care, not long-term custodial help like bathing or meal prep.

Part B: medical insurance

Part B covers the care you get outside the hospital walls, including:

• Doctor visits
• Outpatient services, including many surgeries and tests
• Preventive services such as screenings, vaccines, and the "Welcome to Medicare" visit
• Durable medical equipment (walkers, wheelchairs, oxygen, and similar items)
• Some home health care

For 2026, the standard Part B premium is $202.90 a month. Higher-income beneficiaries pay more through an income-related monthly adjustment amount, known as IRMAA, based on tax returns from two years prior. The 2027 Part B standard premium, the Part B deductible, and the IRMAA income brackets have not yet been announced — CMS typically releases those figures in the fall, usually in November. The Social Security Administration did announce on October 14, 2026 a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.

After you meet the annual Part B deductible, you generally pay 20 percent of the Medicare-approved amount for covered services, and Medicare pays the other 80 percent. That 20 percent has no ceiling under Original Medicare alone, which matters for anyone facing a serious or ongoing illness.

What Original Medicare does not cover

A few important gaps:

• No annual out-of-pocket limit. Your 20 percent share keeps adding up with no cap.
• Most prescription drugs you take at home. For those, you'd add a stand-alone Part D plan.
• Routine dental, vision, and hearing care aren't generally covered.
• Long-term custodial care (help with daily living, over long periods) isn't covered.

Because of these gaps, many people pair Original Medicare with a Part D drug plan and, often, a Medigap (Medicare Supplement) policy that helps pay some of the deductibles and coinsurance Original Medicare leaves behind.

How Part D fits in

If you choose Original Medicare and want drug coverage, you enroll in a stand-alone Part D plan. A few national figures for 2027 to know:

• The out-of-pocket cap on covered Part D drugs is $2,400 (it's $2,100 in 2026). Once you hit it, you pay $0 for the rest of the year on covered drugs.
• The maximum deductible any Part D plan may charge is $700.
• The base beneficiary premium used in the late-enrollment penalty calculation is $41.33. Actual plan premiums are set plan by plan.

If you delay Part D without other creditable drug coverage, a permanent late-enrollment penalty can apply, so most people enroll when first eligible even if they take few medications.

Original Medicare vs. Medicare Advantage — a neutral look

You'll have a choice between staying with Original Medicare (often with Medigap and Part D) or enrolling in a Medicare Advantage (Part C) plan that bundles Parts A, B, and usually D through a private insurer.

Trade-offs run both directions. Original Medicare offers broad nationwide access to any provider that accepts Medicare, standardized federal rules, and the option to add Medigap for predictable cost-sharing — but by itself it has no out-of-pocket cap and no drug coverage. Medicare Advantage plans must cap out-of-pocket spending for Part A and B services, often include drug coverage and extra benefits, and may cost less in premiums — but they use provider networks, often require referrals or prior authorization, and benefits and availability vary by plan and area. Neither path is "better"; the right fit depends on your health, providers, budget, and preferences.

Enrollment windows worth knowing

Annual Enrollment runs October 15 – December 7, 2026, with changes taking effect January 1, 2027. That's when you can join, drop, or switch Part D and Medicare Advantage plans.

If you have Medicaid or qualify for Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also enroll in an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where to learn more

For the most current rules, covered services, and announcements of the 2027 Part B figures and IRMAA thresholds once CMS releases them, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week.