Original Medicare includes Part A, which covers inpatient hospital care, and Part B, which covers outpatient and preventive services and limited medications. Part A is free for most people, while Part B has a premium cost.
Original Medicare is a federal program that provides healthcare for U.S. citizens or permanent U.S. residents ages 65 and older. It also provides coverage for some people with specific conditions and disabilities, regardless of age.
Original Medicare has two parts, Part A and Part B. Read on to learn what they cover, their costs, how to enroll, and more.
Medicare was founded in 1965 as a public health insurance program for older adults managed by the Centers for Medicare & Medicaid Services (CMS).
The program has multiple parts:
Part A and B together are also called Original Medicare.
Part A’s primary funding source is payroll taxes and taxes on Social Security income. On the other hand, Part B is mainly paid for by funds authorized by Congress and the monthly premiums beneficiaries pay.
Medicare Part A covers any treatments you need while you’re hospitalized. It also covers hospice care, skilled nursing facility care, and sometimes a home health aide after discharge.
It’s essential to check your hospital status when receiving hospital treatment, as even some overnight stays may be considered outpatient care. If your doctor confirms you have been admitted as an inpatient, Part A will cover costs. If not, Part B will provide coverage, as Part B covers outpatient medically necessary services such as doctor visits, preventive care, and some limited medications.
Some specific examples of services covered by Medicare Part B include:
- medically necessary care provided by a family doctor or a specialist
- doctor visits you have during an inpatient hospital setting
- outpatient hospital care, such as emergency room treatment
- emergency ambulance transportation
- preventive care, such as mammograms and other types of cancer screenings
- most vaccines, including flu shots and pneumonia shots
- smoking cessation programs
- laboratory tests, blood tests, and X-rays
- durable medical equipment (DME)
- mental health services
- some chiropractic services
- IV medications
- clinical research
What’s not covered by Original Medicare?
The two parts of Original Medicare were designed to cover services needed in hospitals and as an outpatient, but there are some items or services that it does not cover.
Some of the things Original Medicare doesn’t cover include:
- acupuncture
- most take-home prescription medications
- vision care
- dental care
- custodial (long-term) care, such as in residential homes
- services or supplies that are not considered medically necessary
Original Medicare doesn’t cover most take-home prescription medications. You’ll need to purchase a Medicare Part D prescription drug plan, which has its own costs.
Medicare Part A is free for most people who have worked or whose spouses have worked for at least 40 quarters, which is around 10 years.
If this doesn’t apply to you, your premium will vary depending on how long you or your spouse have been employed and paid taxes.
Additional costs related to Part A in 2025 include a deductible that you must pay before coverage kicks in. The deductible applies per benefit period, which begins the day you are admitted to the hospital and ends once you have received no inpatient care for 60 consecutive days.
If you’re hospitalized for over 60 days, you will also incur an additional copayment that increases the longer you remain in the hospital.
For Part B, your 2025 costs are a monthly premium and deductible. Once you have paid the deductible, you will be responsible for 20% of the cost of all treatments. The following charts summarize Medicare’s 2025 costs.
| Part A | Part B | |
|---|---|---|
| Monthly premium | free for most people $285 for people who have worked between 30 and 39 quarters $518 for people who have worked for less than 30 quarters | $185 |
| Deductible | $1,676 per benefit period | $257 per year |
| Copayment | $0 for the first 60 days $419 per day for days 61 to 90 $838 per day for days 90 to 150 while using lifetime reserve days 100% of costs after day 150 | not applicable |
| Coinsurance | not applicable | 20% |
Lifetime reserve days are additional days that Medicare will cover when you’ve been in a hospital for more than 90 days. You can use a total of 60 reserve days during your lifetime. Medicare covers all eligible expenses during this time apart from the daily copayment.
To offset some of Original Medicare’s out-of-pocket costs, you can enroll in a Medigap supplement insurance plan. There are 10 different Medigap plans to choose between, which vary in availability and cost. However, Medigap coverage is standardized.
Medicare typically requires you to use Medicare-approved providers and suppliers when you seek medical care. Most doctors in the United States accept Medicare, but there are exceptions. When you make an appointment, it’s always important to ask if your doctor takes Medicare.
To be eligible for Original Medicare, you must be a U.S. citizen or a permanent U.S. resident who has lived here lawfully for at least 5 consecutive years.
Most people are eligible for Medicare when they are age 65 or older. However, there are exceptions. Some people who are under age 65 are eligible if they or their spouse have received disability benefits from Social Security or Railroad Retirement Board for at least 2 years. People with ALS or ESRD are also eligible for Medicare before they turn age 65.
You can enroll for Medicare online through the Social Security Administration website. You can also enroll by calling Social Security at 800-772-1213 (TTY: 800-325-0778).
If you prefer to enroll in person, you can do so at your local Social Security office. Call first to see if an appointment is required.
Important dates for enrollment
- Initial enrollment: Your initial enrollment period lasts for 7 months. It starts 3 months before you turn age 65 years, continues throughout your birth month, and ends 3 months later.
- Open enrollment: You can change your current plan during open enrollment between October 15 to December 7 each year.
- Medicare Advantage open enrollment: You can switch from one Medicare Advantage plan to another, or back to Original Medical from a Medicare Advantage plan annually from January 1 through March 31.
- Medigap enrollment: This starts 6 months after the first day of the month you apply for Medicare or turn 65 years old. If you miss this enrollment period, you may pay higher premiums or may not be eligible for Medigap.
Medicare Part C (Medicare Advantage) is optional insurance available for Medicare beneficiaries who have Parts A and B. Part C plans legally must cover at least as much as Original Medicare and include extras like vision, dental, and prescription drug coverage.
However, since private insurers administer these plans, they may offer additional coverage.
Do I need both Medicare Advantage and Original Medicare?
No, you cannot have both Original Medicare and Medicare Advantage.
Medicare Advantage plans cover everything Original Medicare covers, but usually include prescription drug, vision, and dental coverage and additional benefits like fitness resources.
Can I drop my Medicare Advantage Plan and go back to Original Medicare?
You can switch from Medicare Advantage back to Original Medicare during the Medicare Advantage open enrollment between January 1 and March 31.
Original Medicare is a federal program designed to provide healthcare for U.S. citizens or permanent U.S. residents ages 65 and older and for those with specific disabilities who are under age 65.
Many people might assume that Medicare is free, but there are costs. However, affordable options within Medicare can fit into most budgets.