Original Medicare: Parts A and B

Original Medicare is a health insurance program managed by the federal government that originated on July 30, 1965 when Lyndon Johnson signed it into law. Its structure is a fee-for-service model that has two parts: Part A is hospital insurance and Part B is medical insurance. On its own, Medicare beneficiaries must satisfy deductibles and then pay co-insurance amounts for Medicare-approved services.

In general, Medicare is available to people 65 and older as well as younger people with certain disabilities like End Stage Renal Disease (ESRD, permanent kidney failure requiring dialysis or transplant), ALS (Lou Gehrig's Disease), and those who are disabled. Disabled individuals may receive Medicare benefits two years after their entitlement date for Social Security Disability Insurance (SSDI).

Medicare eligible individuals can receive coverage for and access to doctors, hospitals, or other health care providers who accept Medicare with no referral required. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee (or co-insurance) for each service received. Generally speaking, there is no cap or Maximum Out Of Pocket limits for co-insurance amounts owed for Medicare-approved services.

Medicare Part A does not have a premium if you or your spouse worked and paid Medicare taxes for 10 years (40 quarters). You must be a U.S. citizen, or a lawful permanent resident who has lived in the U.S. for at least 5 continuous years.

Part A (hospital insurance) covers hospital stays and inpatient care, including:

• Your hospital room and meals
• Special units care, like intensive care
• Drugs and medical supplies used during an inpatient stay
• Lab tests, X-rays and medical equipment as an inpatient
• Operating room and recovery room services
• Skilled nursing services
• Some blood transfusions
• Hospice care, including medications to manage symptoms and pain
• Part-time, skilled care for the homebound after a qualified inpatient stay
• Rehabilitation services after a qualified inpatient stay

Medicare Part B is medical insurance and helps pay for services from doctors and other health care providers. This includes outpatient care, home health care, durable medical equipment, and some preventive services.

Part B coverage has a monthly premium for most people. In 2026 the standard premium is $202.90 per month. Those drawing Social Security benefits can have this amount deducted from their monthly check. It's important to understand that Part B has an annual deductible ($283 in 2026) and once satisfied, Medicare pays 80% of Medicare-approved services, leaving you with a 20% co-insurance.

Higher incomes pay more (IRMAA)

Medicare Part B coverage includes:

• Doctor visits, including when you are in the hospital
• Diabetes screenings, education and certain supplies
• An annual wellness visit and preventive services, like flu shots
• Mental health care
• Clinical laboratory services, like blood and urine tests
• Durable medical equipment for use at home, like wheelchairs and walkers
• X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
• Ambulatory surgery center services
• Some health programs, like smoking cessation and obesity counseling
• Ambulance and emergency room services
• Physical therapy, occupational therapy and speech-language pathology services