Understanding Original Medicare: Parts A & B Explained

If you’re turning 65 or helping a parent get ready for Medicare, the terms “Part A” and “Part B” start showing up everywhere — and it’s not always clear what they actually cover, what they cost, or what happens once you add Medigap, Part D, or Medicare Advantage into the mix. Medicare Part A and Part B, together known as Original Medicare, form the foundation almost every Medicare decision builds on. Get comfortable with the basics first, and the rest of the choices get a lot less overwhelming.

Here’s what Original Medicare actually includes, what it doesn’t, and — because the fine print on Medigap, Part D, and Medicare Advantage is where most people get stuck — how a licensed, independent Medicare broker can help you sort out the rest at no cost.

What Is Original Medicare?

Original Medicare is the federal health insurance program run directly by the government, made up of two parts: Part A (hospital insurance) and Part B (medical insurance). Unlike Medicare Advantage plans, which are sold and administered by private insurance companies, Original Medicare is fee-for-service coverage you get straight from the federal government, and it works with any doctor or hospital nationwide that accepts Medicare.

You typically become eligible for Original Medicare at age 65, though you can qualify earlier if you have certain disabilities or End-Stage Renal Disease (ESRD). Once you’re enrolled, you have a choice to make: you can pair Original Medicare with a supplemental Medigap policy and a standalone Part D drug plan, or you can replace it entirely with a private Medicare Advantage plan. We’ll touch on both options later in this article — and on where to get real, personalized help deciding between them.

Medicare Part A: Hospital Insurance

Medicare Part A is often called hospital insurance, and that’s a fair summary of what it covers: inpatient hospital stays, care in a skilled nursing facility, hospice care, and limited home health services. If you’re admitted to the hospital, Part A is generally what’s picking up the tab for your room, your meals, your nursing care, and the other services tied to your stay.

Most people don’t pay a monthly premium for Part A at all. If you or your spouse paid Medicare taxes for at least 40 quarters (about 10 years) of work, Part A is premium-free. If you don’t meet that threshold, you’ll pay a monthly premium — $565 in 2026 — so it’s worth checking Medicare.gov for the most current figure before you budget for it.

Even premium-free Part A isn’t entirely free at the point of care. In 2026, you’re responsible for a $1,736 deductible for each benefit period, plus daily coinsurance if your hospital or skilled nursing stay runs long. These numbers change annually, so always confirm the current-year figures directly with Medicare.gov.

Medicare Part B: Medical Insurance

Where Part A covers hospital stays, Medicare Part B covers the medical care you receive outside the hospital: doctor visits, outpatient care, preventive services like screenings and vaccines, durable medical equipment (think wheelchairs and walkers), and some home health care.

Unlike Part A, almost everyone pays a monthly premium for Part B — $202.90 in 2026 for most people — plus an annual deductible of $283. If your income is above a certain threshold, you’ll pay more through what’s called an Income-Related Monthly Adjustment Amount, or IRMAA. And if you don’t sign up for Part B when you’re first eligible and don’t have other qualifying coverage, you could face a late enrollment penalty that sticks with you for as long as you have Medicare — so timing your enrollment matters.

What Original Medicare Doesn’t Cover

Original Medicare covers a lot, but it has real gaps worth planning around. There’s no cap on your annual out-of-pocket costs under Original Medicare alone — you’re generally responsible for 20% of the Medicare-approved amount for most doctor services and outpatient care, with no upper limit on how much that 20% can add up to over a year. Original Medicare also doesn’t cover routine dental, vision, or hearing care, doesn’t pay for long-term custodial care (like an extended nursing home stay for daily living help), and doesn’t include prescription drug coverage at all.

Those gaps are exactly why Medigap, Part D, and Medicare Advantage plans exist — each one is designed to fill in different pieces of what Original Medicare leaves out.

Beyond the Basics: Medigap, Part D & Medicare Advantage, at a Glance

Medigap (Medicare Supplement Insurance) is a policy you can buy from a private insurer to help cover the costs Original Medicare leaves to you, like coinsurance, copayments, and deductibles. It’s generally paired with Original Medicare, not Medicare Advantage.

Part D is standalone prescription drug coverage, sold by private insurers and approved by Medicare, that fills the drug-coverage gap in Original Medicare. Plans vary in which medications they cover and what they cost, which is exactly the kind of detail worth comparing before you commit to one.

Medicare Advantage (also called Part C) is a private-plan alternative to Original Medicare that bundles Part A, Part B, and usually Part D into a single plan, often with extra benefits like dental, vision, or hearing coverage — but typically within a specific network of doctors.

Choosing between these options depends on your specific doctors, medications, and budget — which is exactly the kind of comparison a licensed, independent Medicare broker can walk you through in detail, at no cost to you.

How Palm Medical Centers’ Care Team Fits In

A Medicare broker can help you choose the right plan. Palm Medical Centers is here for what comes next: the actual care that plan is meant to cover. Our care team doesn’t sell or recommend specific insurance plans — that’s not our role — but once you’ve chosen the coverage that’s right for you, we’re ready to help you use it, whether that means coordinating your care, keeping track of your health over time, or simply being a doctor’s office that has time for you.

If you’re due for a check-up or haven’t scheduled your Annual Wellness Visit yet, we’d love to see you. Schedule a new patient appointment or Annual Wellness Visit with Palm Medical Centers.

Frequently Asked Questions

Do I have to use a broker to sign up for Medicare?

No. You can enroll in Medicare directly through Social Security or Medicare.gov without ever speaking to a broker. A broker isn’t required to sign up — they’re simply there to help you compare Medigap, Part D, and Medicare Advantage options if you want personalized guidance before you decide. If you’d like that guidance, Palm Medical Centers can set you up with a broker who’s well-versed in the plans we accept, so you can compare your options with the confidence that you’ll be able to stay with your current care team.

Is it really free to talk to a Medicare broker?

Yes. Licensed Medicare brokers are paid by the insurance carriers when a plan is sold, not by you, so there’s no cost to sit down and ask questions or compare your options.

Will a broker try to sell me a specific plan?

An independent broker works with multiple insurance carriers rather than just one, so their job is to help you compare plans that fit your doctors, medications, and budget — not to push a single product. It’s still worth asking upfront which carriers a broker represents.

What’s the difference between a Medicare broker and Palm Medical Centers’ care team?

A Medicare broker helps you choose your insurance coverage. Palm Medical Centers’s care team provides your actual medical care once you’re covered. The two roles are complementary, not competing — we don’t sell insurance plans, and a broker doesn’t provide medical care.

How much does Medicare cost per month in 2026?

Costs vary by what coverage you choose. Most people pay no premium for Part A, while Part B runs $202.90 a month for most beneficiaries in 2026. Medigap, Part D, and Medicare Advantage premiums vary by plan and provider, which is exactly what a licensed, independent Medicare broker can help you compare for your specific situation.