Medicare Part A and Part B (Original Medicare), explained.
Original Medicare covers hospital and medical care — but with significant out-of-pocket costs and no maximum. Here's what's covered, what it costs in 2026, and what most North Carolinians add to fill the gaps.
Original Medicare: Part A and Part B
"Original Medicare" is the federal health insurance you get directly from the U.S. government when you turn 65 (or qualify earlier through disability or End-Stage Renal Disease). It has two parts: Part A (hospital insurance) and Part B (medical insurance). Together, they cover most major medical needs — but with significant out-of-pocket costs that lead most people to add either a Medigap supplement or switch to Medicare Advantage.
Part A — Hospital insurance
What Part A covers
- Inpatient hospital stays (semi-private room, meals, general nursing)
- Skilled nursing facility care (after a qualifying 3-day hospital stay)
- Hospice care for terminal illness
- Some home health care
- Inpatient mental health (limited)
Part A premium and costs in 2026
- Premium: $0/month for most people. You qualify for premium-free Part A if you (or your spouse) paid Medicare taxes for at least 10 years (40 quarters). If you don't qualify, you can buy Part A — up to $518/month in 2026.
- Hospital deductible: $1,676 per benefit period in 2026.
- Coinsurance: $0/day for the first 60 days. Then $419/day for days 61–90. Then $838/day for "lifetime reserve days" (60 total over your life). After that, you pay all costs.
- Skilled nursing facility: $0/day for the first 20 days. Then $209.50/day for days 21–100. After 100 days, you pay all costs.
The gap that surprises people
A 30-day hospital stay under Original Medicare alone could cost you $1,676 (deductible) — and that's just the hospital. Doctor bills during the stay run through Part B, which has its own 20% coinsurance with no out-of-pocket cap. This is the gap that Medigap supplements are designed to fill.
Part B — Medical insurance
What Part B covers
- Doctor visits (primary care and specialists)
- Outpatient services (lab work, imaging, ER visits not admitted)
- Preventive services (annual wellness visits, screenings, vaccines — usually free)
- Mental health (outpatient)
- Durable medical equipment (wheelchairs, walkers, oxygen)
- Some home health care
- Ambulance transportation
- Limited prescription drugs (usually administered in a clinic, not retail pharmacy)
Part B premium and costs in 2026
- Standard premium: $185/month for most people in 2026. Higher earners pay more via IRMAA (Income-Related Monthly Adjustment Amount) — up to ~$628/month at the highest income tier.
- Annual deductible: $257 in 2026.
- Coinsurance: 20% of the Medicare-approved amount for most services, after the deductible. No out-of-pocket maximum. This is why most people add Medigap or switch to Medicare Advantage.
How to enroll in Part A and Part B
Initial Enrollment Period (IEP)
The 7-month window around your 65th birthday: 3 months before your birth month, your birth month, and 3 months after.
- If you're already receiving Social Security retirement benefits, you'll be automatically enrolled in both Part A and Part B starting the month you turn 65.
- If you're not yet receiving Social Security, you need to actively enroll — either online at ssa.gov, by phone, or in person at a Social Security office.
Special Enrollment Period (SEP)
If you're still working at 65 and have credible employer health coverage (typically from an employer with 20+ employees), you can usually delay Part B without penalty. When you eventually leave that coverage, you have an 8-month SEP to enroll in Part B without penalty.
General Enrollment Period (GEP)
January 1 to March 31 each year. For people who missed both their IEP and any SEP. Coverage starts the month after enrollment, and you may face a permanent late-enrollment penalty for Part B (10% of the premium per 12 months you were eligible but didn't enroll).
What Original Medicare doesn't cover
This is where most people get caught off guard:
- Routine dental (cleanings, fillings, dentures)
- Routine vision (eye exams, glasses, contacts)
- Routine hearing (exams, hearing aids)
- Long-term custodial nursing home care
- Most prescription drugs (you need separate Part D)
- Care outside the U.S. (with very limited exceptions)
- Cosmetic surgery
What most people add to Original Medicare
Almost no one walks around with just Parts A and B because of the unlimited 20% Part B coinsurance and the gaps above. The two common add-on paths:
Path 1: Original Medicare + Medigap + Part D
Add a Medigap supplement (Plan G is most popular) to cover the deductibles and coinsurance. Add a stand-alone Part D plan for prescription drugs. Add stand-alone dental/vision if needed. Highest monthly cost but most predictable out-of-pocket and most provider freedom.
Path 2: Replace Original Medicare with Medicare Advantage (Part C)
Switch your Medicare benefits to a private Medicare Advantage plan. Often $0 premium, bundled drug coverage, and extras like dental and vision — but you use the plan's HMO or PPO network.
We compare both paths for you side-by-side. Book a free 15-minute call and let's figure out which fits.
Frequently asked questions
Do I have to enroll in Medicare at 65?
Not necessarily. If you have credible employer coverage (typically from an employer with 20+ employees), you can usually delay Part B without penalty. We always recommend enrolling in Part A at 65 if it's premium-free, and confirming with HR that your employer plan is creditable.
Why is my Part B premium higher than $185/month?
Income-Related Monthly Adjustment Amount (IRMAA) increases your Part B premium based on income from your tax return two years prior. If your modified adjusted gross income exceeded certain thresholds, you'll pay a higher premium. The IRMAA is reassessed annually based on your most recent tax return.
Can I appeal an IRMAA charge?
Yes, in certain situations called 'life-changing events': retirement, marriage or divorce, death of a spouse, loss of pension income, and a few others. You file Form SSA-44 with documentation. We help clients navigate this.
How do I delay Part B if I'm still working?
If your employer has 20+ employees and you're enrolled in their group health plan, you can typically decline Part B at 65. Get written confirmation from HR that your employer plan is creditable. Then enroll in Part B during your 8-month Special Enrollment Period after you leave the job. We coach clients through this every week.
Is Part A really free?
Yes — for most people. If you (or your spouse) paid Medicare taxes for at least 40 quarters (10 years), you get Part A premium-free. If not, you can buy Part A: $284/month in 2026 with 30–39 quarters of work history, or $518/month with fewer than 30 quarters.
Do I need a Medigap or Medicare Advantage plan in addition to Parts A and B?
Most people end up adding one or the other. Original Medicare alone has a 20% Part B coinsurance with no out-of-pocket maximum, plus significant Part A deductibles and gaps. Medigap fills those gaps; Medicare Advantage replaces Original Medicare with a bundled private plan. We compare both for you.
Related coverage
Other things I can help you with.
Approaching 65? Let's plan your enrollment.
Free 15-minute call. I'll walk you through the enrollment timeline, IRMAA, employer coverage coordination, and what to add to Parts A and B.