TL;DR
Original Medicare is Parts A (hospital) and B (medical). It covers most inpatient and outpatient care but leaves gaps in deductibles, coinsurance, dental, vision, hearing, and prescription drugs. Most beneficiaries pair it with either a Medicare Supplement (Medigap) plus a Part D plan, or with a Medicare Advantage plan.
What Part A covers
Part A is the hospital-insurance half of Original Medicare. It pays for inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice care, and some home health services.
Most people pay no Part A premium because they or a spouse paid Medicare taxes for at least 10 years (40 quarters) while working. There is, however, a Part A deductible for each benefit period — reset by 60 days of no inpatient care.
- Inpatient hospital care (semi-private room, meals, general nursing, drugs administered during the stay).
- Skilled nursing facility care following a 3-day inpatient hospitalization.
- Hospice care for terminally ill patients with a life expectancy of six months or less.
- Home health care that is medically necessary, part-time or intermittent.
What Part B covers
Part B is the medical-insurance half. It pays for doctor visits, outpatient care, preventive services, durable medical equipment, most lab work, and mental-health services.
Part B has a monthly premium (adjusted by income through IRMAA), a small annual deductible, and after that Medicare typically pays 80% of the approved amount for most services — leaving you responsible for the remaining 20% with no cap.
Important: no out-of-pocket maximum
Original Medicare has no yearly cap on what you pay in coinsurance. A serious illness can generate thousands in 20% cost-sharing. This is the single biggest reason most beneficiaries pair Original Medicare with a Medicare Supplement (Medigap) plan or choose a Medicare Advantage plan instead.
What Original Medicare does not cover
- Most prescription drugs (you need a stand-alone Part D plan).
- Routine dental, vision, and hearing care.
- Long-term custodial care in a nursing home.
- Most care received outside the United States.
How to fill the gaps
There are two common paths. A Medicare Supplement (Medigap) (Medicare Supplement (Medigap)) policy pairs with Original Medicare and covers most or all of your share of costs, and you add a stand-alone Part D drug plan. A Medicare Advantage (Part C) plan replaces Original Medicare with a private plan that usually includes drug coverage plus extras like dental, vision, and a gym benefit.
There is no single best path — the right answer depends on your doctors, your medications, how often you travel, and your budget. Scott's job is to walk through both options honestly and help you choose.
