What Part A and Part B cover
Medicare Part A covers hospital stays, skilled nursing care after a hospital stay, hospice care, and some home health services. Medicare Part B covers doctor visits, outpatient care, medical equipment, and preventive services like screenings and vaccines. Together, they form the foundation of Original Medicare — the government-run plan most people turn to at age 65.
Part A is hospital insurance. If you are admitted to a hospital, Part A pays the bulk of the cost after you meet your deductible. It also covers up to 100 days in a skilled nursing facility if you need rehabilitation after a hospital stay of at least three days. Part B is medical insurance. It covers what happens in a doctor's office, an urgent care clinic, or an outpatient surgery center — the care you receive without being admitted to a hospital overnight.
Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. Part B does charge a monthly premium, which varies based on your income. The amount you pay out of pocket for each service — the deductible, copay, or coinsurance — depends on which service you use and which plan you have chosen.
Key Takeaways
- Part A covers hospital stays and skilled nursing care; Part B covers doctor visits and outpatient services.
- Most people pay no monthly premium for Part A but do pay a monthly premium for Part B based on income.
- You must be enrolled in both Part A and Part B to have Original Medicare coverage.
- Each part has its own deductible and cost-sharing rules that you pay before or after the insurance pays.
Part A: Hospital and inpatient care
Part A begins the moment you are admitted to a hospital as an inpatient. You pay a deductible for each benefit period — currently $1,676 for 2024, though this amount changes yearly. After you meet that deductible, Part A covers all hospital costs for the first 60 days. From day 61 to day 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you can use lifetime reserve days, but those have a higher daily cost and are limited.
Skilled nursing facility care is covered only if you were admitted to a hospital first and stayed at least three nights. Part A then covers up to 100 days in the facility. You pay nothing for the first 20 days, then a daily coinsurance amount from day 21 to day 100. After 100 days, you pay the full cost yourself.
Part A also covers hospice care if you are diagnosed with a terminal illness and choose comfort care instead of treatment. It covers home health services — nursing, physical therapy, and medical equipment — if a doctor orders them and you are homebound. These services are covered at no cost to you beyond what you already paid in premiums.
Part B: Doctor visits and outpatient services
Part B covers visits to your primary care doctor, specialists, and urgent care clinics. It pays for lab tests, imaging like X-rays and ultrasounds, and procedures done in an outpatient setting. It also covers durable medical equipment — wheelchairs, walkers, oxygen equipment — if your doctor prescribes it. Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost to you.
You pay a yearly deductible for Part B — $240 for 2024 — before Part B starts paying. After you meet the deductible, you typically pay 20 percent of the cost of each service, and Medicare pays 80 percent. Your doctor's office bills Medicare directly, and Medicare sends you an explanation of benefits showing what was paid and what you owe.
Part B does not cover routine dental care, vision exams for glasses, or hearing aids. It also does not cover prescription drugs — that is covered under Part D, a separate plan you can add. If you need these services, you can buy a separate plan or pay out of pocket.
How enrollment works and when to sign up
You become may be able to access for Medicare at age 65. If you are already receiving Social Security benefits, you are enrolled in Part A and Part B automatically three months before the month you turn 65. If you are not yet receiving Social Security, you must sign up yourself during your Initial Enrollment Period, which runs from three months before your 65th birthday through three months after.
If you miss your Initial Enrollment Period and do not have other health coverage, you may pay a penalty for the rest of your life. Part B has a penalty of 10 percent of the monthly premium for each year you delayed. Part A has a penalty only if you did not have coverage through an employer plan.
You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The process takes about 10 minutes online and is free.
Original Medicare versus Medicare Advantage
Part A and Part B together make up Original Medicare, the fee-for-service plan run by the federal government. You can see any doctor or hospital that accepts Medicare, and there are no networks to worry about. You pay the deductibles and coinsurance described above.
Alternatively, you can use your Part A and Part B coverage to join a Medicare Advantage plan (Part C), which is run by a private insurance company. Medicare Advantage plans often have lower monthly premiums and may include prescription drug coverage and dental or vision benefits. However, they typically have networks — you must see doctors within the plan's network, except in emergencies. They also cap your out-of-pocket costs, which Original Medicare does not.
You cannot have both Original Medicare and Medicare Advantage at the same time. You choose one or the other when you first turn 65, and you can switch during the annual open enrollment period in the fall.
What you pay: Deductibles, copays, and coinsurance
Original Medicare uses deductibles and coinsurance, not copays. A deductible is the amount you pay before Medicare starts paying. Coinsurance is a percentage of the cost you pay after the deductible is met. Part A and Part B each have their own deductible.
| Service | Deductible | Your Cost After Deductible |
|---|---|---|
| Hospital stay (Part A) | $1,676 per benefit period | $0 for days 1–60; coinsurance for days 61–90 |
| Doctor visit (Part B) | $240 per year | 20% coinsurance |
| Preventive service (Part B) | None | $0 |
| Skilled nursing facility (Part A) | None (after hospital stay) | $0 for days 1–20; coinsurance for days 21–100 |
These amounts change each year. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE. If you cannot afford these costs, you may be able to get help through a program called Medicaid or a Medicare Savings Program, which varies by state.
Questions to ask your doctor
Before a procedure or test, ask your doctor whether it is covered by Part A or Part B, and what your out-of-pocket cost will be. Ask whether the facility or lab they are using accepts Medicare. If you are considering a procedure that is not routine, ask whether Medicare will cover it or whether you will need to sign a form saying you understand it may not be covered.
If you receive a bill that seems wrong, ask your doctor's office to explain it or to contact Medicare on your behalf. You have the right to see an itemized bill and to ask questions about any charge.
Frequently Asked Questions
Do I have to take Part B when I turn 65?
No, but if you delay and do not have other health coverage, you will pay a 10 percent penalty on your Part B premium for as long as you have Medicare. If you are still working and have health insurance through your job, you can delay Part B without penalty as long as you enroll within eight months of leaving that job.
What happens if I see a doctor who does not accept Medicare?
You pay the full cost yourself. Medicare will not reimburse you. Before scheduling an appointment, ask the doctor's office whether they accept Medicare. You can also search for doctors on Medicare.gov.
Does Part A or Part B cover prescription drugs?
Neither. Prescription drug coverage is Part D, a separate plan you can add when you first turn 65 or during the annual open enrollment period. If you do not sign up when you are first may be able to access and later decide you want it, you may pay a penalty.
Can I use Part A and Part B with a Medigap plan?
Yes. A Medigap plan (also called Medigap insurance) is a private insurance policy that pays some of the costs that Original Medicare does not cover — deductibles, coinsurance, and copays. You keep your Part A and Part B and add Medigap on top. You cannot have both Medigap and Medicare Advantage at the same time.
What if I cannot afford my Part B premium?
If your income is low, you may be able to get help through your state's Medicare Savings Program. This program pays your Part B premium and sometimes your deductibles and coinsurance. Contact your state Medicaid office or call 1-800-MEDICARE to find out whether you may have access to.