Original Medicare at a Glance — 2026
Part A
Hospital Insurance
Free for most
Part B
Medical Insurance
$202.90/mo
Part D
Drug Coverage
Separate plan
What Is Original Medicare?
"Original Medicare" refers to the federal health insurance program administered directly by the Centers for Medicare & Medicaid Services (CMS), consisting of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). It does not include prescription drug coverage (Part D) or the extra benefits offered by Medicare Advantage.
With Original Medicare, you can see any doctor or hospital that accepts Medicare — anywhere in the country — without referrals. This flexibility is the primary advantage over Medicare Advantage, which uses provider networks.
Original Medicare = Part A + Part B. You add Part D for prescriptions and optionally Medigap to cover cost-sharing gaps. Together, these four layers provide comprehensive coverage.
Medicare Part A — Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility (SNF) care following hospitalization, hospice care, and some home health care.
Part A Premium
Most people pay $0 for Part A because they (or their spouse) paid Medicare taxes for at least 40 quarters (10 years) of work. Those with fewer work credits pay a premium:
| Work Credits (Quarters) |
Monthly Premium |
| 40+ quarters |
$0 (premium-free) |
| 30–39 quarters |
$285/month |
| Fewer than 30 quarters |
$518/month |
Part A Cost-Sharing
| Service |
Your Cost |
| Inpatient deductible (per benefit period) |
$1,736 |
| Hospital days 1–60 |
$0 (deductible covers) |
| Hospital days 61–90 |
$434/day coinsurance |
| Hospital days 91–150 (lifetime reserve) |
$868/day coinsurance |
| Hospital beyond 150 days |
100% (all costs) |
| Skilled nursing days 1–20 |
$0 |
| Skilled nursing days 21–100 |
$194/day coinsurance |
| Skilled nursing beyond 100 days |
100% (all costs) |
Benefit periods: The Part A deductible applies per benefit period, not per year. A benefit period begins when you're admitted as an inpatient and ends 60 days after discharge. You could owe the $1,736 deductible more than once per year if you have multiple hospitalizations.
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Medicare Part B — Medical Insurance
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services. It's the part of Medicare most people use most often.
Part B Premium
The standard 2026 Part B premium is $202.90/month. Higher-income beneficiaries pay more through IRMAA (Income-Related Monthly Adjustment Amount), based on their 2024 tax return.
Part B Deductible & Coinsurance
| Cost Item |
Your Cost |
| Annual deductible |
$283/year |
| Coinsurance after deductible |
20% of Medicare-approved amount |
| Annual out-of-pocket cap (Part B alone) |
None |
| Excess charges (non-participating providers) |
Up to 15% above approved amount |
The 20% gap: Without Medigap, you pay 20% of every covered service indefinitely. A major surgery or cancer treatment can result in tens of thousands of dollars in cost-sharing since there is no annual cap. This is the primary reason many beneficiaries add Medigap coverage.
What Part B Covers
- Doctor visits (primary care and specialists)
- Outpatient surgery
- Emergency room visits
- Ambulance services
- Mental health services
- Physical, occupational, speech therapy
- Preventive care (flu shots, cancer screenings)
- Durable medical equipment (wheelchairs, walkers)
- Home health care (skilled nursing at home)
- Chemotherapy and radiation
- Diabetes supplies
- Annual Wellness Visit
Medicare Part D — Prescription Drug Coverage
Part D is optional prescription drug coverage provided through private insurers approved by Medicare. Standalone Part D plans work alongside Original Medicare; Medicare Advantage plans with drug coverage (MA-PD) bundle everything together.
| Cost Item |
2026 Amount |
| Base beneficiary premium (national average) |
$38.99/month |
| Maximum deductible |
$590/year |
| Out-of-pocket cap |
$2,100/year (then $0) |
| Insulin cap |
$35/month |
Since 2025, the IRA's $2,000 cap (now $2,100 in 2026) has eliminated the catastrophic cost risk for high drug users. See our Part D $2,100 cap guide for details.
Late enrollment penalty: If you don't enroll in a creditable Part D plan within 63 days of Medicare Part B eligibility, and later want coverage, you'll owe a permanent penalty. Use our
Part D penalty calculator to estimate the cost.
The 20% Gap — and the Medigap Solution
The most significant cost risk in Original Medicare is the unlimited 20% Part B coinsurance. Consider these scenarios:
| Scenario |
Medicare-Approved Amount |
Your 20% Without Medigap |
| Knee replacement surgery |
$25,000 |
$5,000 |
| Cancer treatment (one year) |
$150,000 |
$30,000 |
| 60-day hospital stay |
$100,000 |
$1,736 deductible only (Part A covers hospital) |
| Chemotherapy + radiation |
$80,000 |
$16,000 |
Medigap Plan G (most popular for new enrollees) covers the 20% coinsurance, hospital coinsurance, and excess charges. For about $100–$200/month, you convert unpredictable 20% cost-sharing into a predictable monthly premium.
See our Medigap plans comparison for full coverage details and typical premiums.
What Original Medicare Doesn't Cover
Not Covered
- Routine dental care (cleanings, fillings, dentures)
- Routine vision care (exams, glasses, contacts)
- Hearing aids and exams
- Prescription drugs (need Part D)
- Long-term custodial care (nursing home)
- Care outside the U.S. (with limited exceptions)
- Cosmetic surgery
- Acupuncture (except for chronic low back pain)
How to Fill the Gaps
- Dental: Standalone dental insurance, Medicare Advantage
- Vision: Standalone vision plan, Medicare Advantage
- Hearing: Standalone coverage, Medicare Advantage
- Rx drugs: Medicare Part D plan
- Long-term care: Long-term care insurance, Medicaid
- Travel: Travel insurance, Medigap Plans D/G/N/M
- 20% gap: Medigap supplement plan
Should You Choose Original Medicare or Medicare Advantage?
The right choice depends on your health, finances, and priorities. Here are the key trade-offs:
| Consider Original Medicare + Medigap if… |
Consider Medicare Advantage if… |
| You want to see any doctor without referrals |
You prefer an all-in-one plan with one card |
| You travel frequently or divide time between states |
You want dental, vision, hearing in one plan |
| You want predictable costs (Medigap covers gaps) |
You're generally healthy and use little care |
| You have complex medical needs and see many specialists |
You want a $0 additional plan premium |
| You want maximum provider choice |
You're comfortable with network restrictions |
Try our Medicare Advantage vs. Original Medicare calculator to estimate which option saves more money for your situation.
Frequently Asked Questions
No. Original Medicare (Parts A and B) does not have an annual out-of-pocket cap. Your 20% Part B coinsurance can accumulate indefinitely for expensive conditions. Medigap plans can cover these costs for a predictable monthly premium. Medicare Advantage plans do have a capped OOP maximum ($9,350 in-network for 2026).
Most people auto-enroll in both when they turn 65 if they're already receiving Social Security. If not, you need to sign up during your Initial Enrollment Period. Part A is usually free, so most people take it. Part B has a premium and some people with employer coverage delay enrollment. See our
enrollment periods guide to understand your timing.
Medicare sets a fee schedule that limits what it will pay for covered services (the "approved amount" or "Medicare-approved amount"). If you see a "participating" provider, they accept this amount in full. If you see a "non-participating" provider, they can charge up to 15% more (excess charges). Medigap Plan G covers excess charges; Plan N does not.
Generally no. Original Medicare only covers care in the United States and its territories, with very limited exceptions (e.g., a Canadian hospital that is closer to your home than a U.S. hospital when traveling between Alaska and the lower 48 states). Medigap Plans D, G, M, and N cover 80% of foreign travel emergency costs (up to plan limits, after a $250 deductible).
Yes. During the Annual Enrollment Period (October 15–December 7), you can switch from Original Medicare to a Medicare Advantage plan, or vice versa. Changes take effect January 1. You can also make one switch during the Medicare Advantage Open Enrollment Period (January 1–March 31). If you're switching back to Original Medicare, you may want Medigap coverage — but be aware you may face medical underwriting outside your guaranteed issue window.
Disclaimer: MedicareBudget.net provides general educational information about Medicare costs and coverage. We are not affiliated with the Centers for Medicare & Medicaid Services (CMS), Social Security Administration (SSA), or any government agency. Cost-sharing figures shown reflect 2026 CMS data. Actual costs depend on your specific plan, providers, and services used. This content is not a substitute for advice from a licensed insurance agent or qualified benefits counselor. Always verify current information at
medicare.gov.