What to Know About Original Medicare

Original Medicare — the combination of Part A (hospital insurance) and Part B (medical insurance) — is the federal health coverage program that most Americans become eligible for at age 65. Understanding exactly what Original Medicare does and doesn't cover is essential before you decide whether to add supplemental coverage.

Since Medicare's creation in the 1960s, additional plan types have been introduced — Medicare Advantage, Medicare Supplement (Medigap), and Part D prescription drug plans. Each one builds on Original Medicare in a different way. Before exploring those options, it helps to know exactly what the baseline program provides.

Nearly one million providers across the U.S. accept Medicare. Because Original Medicare does not use provider networks, you can see any doctor or hospital that accepts Medicare — no referrals needed. That nationwide flexibility is one of the biggest advantages of staying on Original Medicare rather than switching to a network-based plan.

What Is Covered by Original Medicare?

Original Medicare is split into two distinct parts, each covering different types of care:

• Part A (Hospital Insurance) — covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people pay no monthly premium for Part A if they or a spouse paid Medicare taxes for at least 10 years.
• Part B (Medical Insurance) — covers doctor visits, outpatient care, preventive services, durable medical equipment (DME), and medically necessary lab tests. Part B carries a standard monthly premium that adjusts annually.

Out-of-Pocket Costs Under Original Medicare

One important detail many people overlook: Original Medicare has no annual out-of-pocket maximum. That means your costs can keep growing if you need extensive care. Here's how the cost-sharing works:

• Part A deductible — you pay this each benefit period (not once a year). If you're hospitalized, discharged, and re-admitted, you may owe the deductible again.
• Part B deductible — paid once per calendar year. After that, you typically pay 20% coinsurance on Part B services with no upper limit.
• Part B premium — most beneficiaries pay the standard amount, though higher earners may pay more due to IRMAA surcharges.

This is exactly why many beneficiaries add a Medicare Supplement plan — Medigap policies are specifically designed to cover the deductibles and coinsurance that Original Medicare leaves behind, giving you more predictable costs throughout the year.

What Is Not Covered by Original Medicare?

Original Medicare leaves several common services uncovered. You'll need additional coverage for:

• Prescription drugs — Original Medicare covers some drugs administered in a clinical setting, but not medications you pick up at the pharmacy. You'll need a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.
• Vision care — routine eye exams and glasses are not covered.
• Dental care — routine cleanings, fillings, and dentures are excluded.
• Hearing aids — routine hearing exams and hearing devices are not covered.
• Long-term custodial care — extended nursing home stays for non-skilled care are not a Medicare benefit.
• Care outside the U.S. — with very limited exceptions, Medicare doesn't pay for services received abroad.

Filling the Gaps: Medicare Advantage vs. Medicare Supplement

There are two main paths to add coverage beyond Original Medicare, and they work very differently:

Medicare Advantage (Part C) replaces Original Medicare with an all-in-one plan from a private insurer. Most Advantage plans include drug coverage and extras like dental, vision, and hearing — often with $0 additional premium. The trade-off is that you'll typically use a provider network (HMO or PPO) and may need referrals. Check our Medicare Advantage FAQ for a deeper dive.

Medicare Supplement (Medigap) works alongside Original Medicare rather than replacing it. You keep the freedom to see any Medicare-accepting provider nationwide, and the Medigap policy pays some or all of the cost-sharing Original Medicare leaves you with. You'll still need a separate Part D plan for prescriptions.

Choosing between these paths depends on your budget, your doctors, and how much flexibility matters to you. A step-by-step plan comparison checklist can help you weigh the trade-offs side by side.

How to Get Started

If you're approaching age 65 or otherwise becoming eligible for Medicare, your Initial Enrollment Period is the best time to lock in coverage without penalties. To explore your options and find the right combination of plans for your needs and budget, compare plans on MedicareSignups.com or connect with a licensed agent who can walk you through the details.