What Is Medicare? Part A vs. Part B Explained
Medicare has multiple parts and each covers something different. Here’s a plain-language breakdown of what Part A and Part B actually cover, what they cost, and where the gaps are.
Part A (Hospital)
$0 Premium
For most people with 40+ work quarters
Part B (Medical)
$185/mo
Standard 2026 premium (may be higher with IRMAA)
Coverage Gap
20%
What you owe on most Part B services after the deductible
Medicare Part A: Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people don’t pay a monthly premium for Part A because they (or their spouse) paid Medicare taxes for at least 40 quarters (10 years) while working.
| What Part A Covers | 2026 Cost to You |
|---|---|
| Inpatient hospital stay (days 1–60) | $1,736 deductible per benefit period |
| Inpatient hospital stay (days 61–90) | $433/day coinsurance |
| Inpatient hospital stay (days 91+) | $866/day (lifetime reserve days) |
| Skilled nursing facility (days 1–20) | $0 |
| Skilled nursing facility (days 21–100) | $216.50/day |
| Hospice care | $0 for most services |
| Home health care (if eligible) | $0 |
Medicare Part B: Medical Insurance
Part B covers doctor visits, outpatient services, preventive care, lab tests, durable medical equipment, and some home health services. Unlike Part A, Part B requires a monthly premium from everyone enrolled.
| What Part B Covers | 2026 Cost to You |
|---|---|
| Annual Part B deductible | $257 (you pay this first) |
| Doctor visits and outpatient services | 20% after deductible (no cap) |
| Preventive services (annual wellness visit, screenings) | $0 (no deductible or coinsurance) |
| Durable medical equipment | 20% after deductible |
| Mental health services (outpatient) | 20% after deductible |
| Ambulance services | 20% after deductible |
What Medicare Does NOT Cover
Original Medicare (Parts A and B) has significant gaps. Understanding what isn’t covered is just as important as knowing what is:
Not covered by Original Medicare: Routine dental, vision, and hearing care — Prescription drugs (requires Part D or MAPD) — Long-term care / nursing home custodial care — Cosmetic procedures — Most care received outside the United States
The most significant financial gap in Original Medicare is the unlimited 20% coinsurance under Part B. There is no cap — if you have a $200,000 surgery, your 20% share is $40,000. This is the core reason most people on Original Medicare add either a Medigap plan or Medicare Advantage.
Have questions about what Medicare covers in your specific situation? We’ll walk through it with you — no cost, no pressure.
Book a Free Review