How Medicare Parts A & B Work: A Simple Guide for New Beneficiaries

When you turn 65, Original Medicare is made up of two main parts: Part A and Part B. Understanding how these two parts work is the foundation for making smart Medicare decisions.

Here’s a straightforward breakdown of what Medicare Part A and Part B cover, what they cost, and how they work together.

Medicare Part A: Hospital Insurance

Part A helps cover inpatient hospital care and certain other facility-based services.

What Part A Covers:

• Inpatient hospital stays (semi-private room, meals, general nursing, and medications while inpatient)
• Skilled nursing facility care (limited time after a qualifying hospital stay)
• Hospice care
• Some home health care services

What Part A Does NOT Cover:

• Long-term custodial care (assisted living or nursing home care for daily living needs)
• Private hospital rooms or personal comfort items

Cost of Part A:

• Most people get premium-free Part A if you or your spouse paid Medicare taxes for at least 10 years (40 quarters).
• If you have fewer than 40 quarters, you may have to pay a monthly premium (up to several hundred dollars per month in 2026).
• 2026 Deductible: $1,676 per benefit period (this resets if you’re out of the hospital for 60 days).

After the deductible, Medicare pays most costs for up to 60 days. You pay a daily coinsurance amount for days 61–90, and much higher amounts after that (lifetime reserve days).

Medicare Part B: Medical Insurance

Part B covers outpatient medical care — the services you receive outside of a hospital stay.

What Part B Covers:

• Doctor visits (primary care and specialists)
• Preventive services (annual wellness visits, screenings, mammograms, colonoscopies, vaccines)
• Outpatient procedures and surgeries
• Emergency room visits (when not admitted)
• Diagnostic tests, X-rays, and lab work
• Durable medical equipment (walkers, wheelchairs, etc.)
• Mental health services
• Ambulance services (when medically necessary)

What Part B Does NOT Cover:

• Prescription drugs (that’s Part D)
• Dental, vision, and hearing care
• Routine foot care
• Cosmetic procedures

Cost of Part B:

• Standard monthly premium in 2026: $202.90
• Higher-income individuals pay more (Income-Related Monthly Adjustment Amount – IRMAA)
• Annual Deductible (2026): $283
• After the deductible, you typically pay 20% coinsurance of the Medicare-approved amount for most services.

How Parts A & B Work Together (Original Medicare)

• You must have both Part A and Part B to have full Original Medicare.
• Original Medicare pays 80% of the approved amount for most Part B services after the deductible.
• You are responsible for the remaining 20%, plus any deductibles.
• There is no annual out-of-pocket maximum with Original Medicare alone. This is why many people add a Medigap (Medicare Supplement) policy.

Key Things to Know About Parts A & B

• You can see any doctor or hospital in the U.S. that accepts Medicare (most do).
• Services must be medically necessary and approved by Medicare.
• You will receive a Medicare Summary Notice (MSN) every 3 months showing what was billed and what Medicare paid.
• Parts A & B do not include prescription drug coverage or extras like dental and vision.

Next Steps After Understanding Parts A & B

Once you know how Parts A and B work, you have two main paths:

1. Stay with Original Medicare + add a Medigap policy + a Part D drug plan, or
2. Choose a Medicare Advantage plan (Part C) that bundles everything together.

Each path has pros and cons depending on your health needs, doctors, budget, and travel plans.

Get Personalized Help Choosing the Right Path

Medicare Parts A and B form the foundation, but the real decision is how you’ll fill the gaps. That’s where having the right supplemental coverage makes a big difference in your total costs and peace of mind.

If you’re turning 65 or helping a loved one, I’d be happy to walk you through your options in plain English. I can show you how different choices affect your out-of-pocket costs based on your specific doctors and prescriptions.

Contact me today for a no-obligation Medicare review. Whether you prefer Original Medicare with a Medigap plan or a Medicare Advantage plan, I’ll help you find the best fit for your situation — at no extra cost to you.

This article is for educational purposes only. Medicare premiums, deductibles, and benefits are updated annually by the federal government. Figures shown are based on 2026 amounts. Always verify your personal eligibility and current costs with official Medicare sources or a licensed advisor.