Original Medicare is the federal health insurance program run directly by the Centers for Medicare & Medicaid Services (CMS)

Original Medicare is the traditional Medicare program — the one most people think of when they hear the word Medicare. It consists of two parts: Part A covers hospital care, and Part B covers doctor visits and outpatient services. You receive a card from the federal government, and you can see any doctor or hospital in the country that accepts Medicare. There is no network, no gatekeeper, and no requirement to choose a primary care doctor.

Original Medicare is different from Medicare Advantage (Part C), which is a private insurance alternative that bundles Parts A and B together. If you enroll in Original Medicare, you are using the government program itself, not a private plan. Most people become may be able to access for Medicare at age 65, though some younger people with disabilities or end-stage renal disease can enroll earlier.

Key Takeaways

  • Original Medicare Part A covers hospital stays, skilled nursing care, hospice, and home health services after a hospital stay.
  • Original Medicare Part B covers doctor visits, outpatient surgery, lab tests, imaging, and preventive care like screenings and vaccines.
  • You pay a monthly premium for Part B, a deductible when you use services, and coinsurance (a percentage of the cost) for most care.
  • Original Medicare has no network restrictions — you can see any doctor or hospital that accepts Medicare anywhere in the country.
  • Most people with Original Medicare also buy a Medigap (supplemental) policy to cover the costs Medicare does not pay.

What Part A Covers

Part A covers inpatient hospital care, including room, meals, nursing care, and necessary medications and supplies while you are admitted. It also covers skilled nursing facility care (not custodial care in a nursing home) for up to 100 days after a may have access to hospital stay of at least three days. Part A covers home health services — nursing, physical therapy, occupational therapy — when ordered by a doctor and provided by a Medicare-certified agency. Hospice care for people with a terminal illness is also covered under Part A.

Part A is funded through payroll taxes you paid during your working years. If you or your spouse paid Medicare taxes for at least 10 years, you do not pay a monthly premium for Part A. If you did not work long enough, you can buy Part A coverage, but the monthly cost varies based on how many years you or your spouse paid in. Most people have Part A automatically when they turn 65.

What Part B Covers

Part B covers doctor visits (primary care and specialists), outpatient surgery, emergency room visits, lab tests, X-rays and imaging, mental health services, and preventive care. Preventive services covered at no cost include annual wellness visits, cancer screenings (mammogram, colonoscopy, Pap test), cardiovascular screenings, bone density tests, diabetes screenings, and vaccines (flu, pneumonia, shingles, COVID-19). Part B also covers durable medical equipment like wheelchairs, walkers, and oxygen, though you typically pay 20 percent of the cost after you meet your deductible.

Part B requires a monthly premium, which changes each year. The standard premium in 2024 is $164.90 per month for most people, though higher-income beneficiaries pay more. You also pay an annual deductible (currently $240) before Part B coverage begins. After you meet the deductible, you typically pay 20 percent coinsurance for most services. Part B does not cover routine dental, vision, or hearing care, though some preventive eye exams are covered.

How Much You Pay Out of Pocket

Original Medicare has three types of costs: premiums, deductibles, and coinsurance. Part A has no monthly premium for most people, but it has a deductible per hospital stay (currently $1,556 in 2024). Part B has a monthly premium and an annual deductible. After you meet the Part B deductible, you pay 20 percent of the approved amount for most services — the doctor or hospital bills Medicare first, then bills you for your share.

There is no annual out-of-pocket maximum under Original Medicare. If you have a serious illness or injury, your costs can grow very large. This is why most people with Original Medicare also buy a Medigap (supplemental insurance) policy, which covers some or all of the deductibles, coinsurance, and copayments that Medicare does not pay. Medigap premiums vary by plan and location but typically range from $100 to $300 per month.

Enrollment and When to Sign Up

You become may be able to access for Medicare at age 65. You can enroll during your Initial Enrollment Period, which runs three months before the month you turn 65, through three months after. If you delay enrolling in Part B without a valid reason (such as still being covered by employer health insurance), you may face a permanent penalty of 10 percent added to your Part B premium for each year you delayed. Part A has no penalty for late enrollment if you are may be able to access for it free.

You enroll through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or legal residency, and information about any current health coverage. If you are already receiving Social Security benefits, you are enrolled in Parts A and B automatically unless you decline Part B.

Original Medicare Versus Medicare Advantage

Original Medicare and Medicare Advantage (Part C) are two different ways to get your Medicare benefits. Original Medicare is the government program with no network — you can see any doctor or hospital that accepts Medicare. Medicare Advantage is a private insurance plan that bundles Parts A and B (and usually Part D prescription drug coverage) into one plan. Most Medicare Advantage plans have networks, lower monthly premiums, and annual out-of-pocket maximums, but you may pay more per visit and have fewer choices of doctors and hospitals.

You cannot have both Original Medicare and Medicare Advantage at the same time. When you first turn 65, you choose one or the other. If you choose Original Medicare, you can switch to Medicare Advantage later during the Annual Enrollment Period (October 15 to December 7 each year). If you switch back to Original Medicare after having Medicare Advantage, you may not be able to buy a Medigap policy without medical underwriting, depending on your state and circumstances.

Prescription Drug Coverage (Part D)

Original Medicare does not include prescription drug coverage. If you want drug coverage, you must enroll in a separate Part D plan offered by a private insurance company. Part D plans vary in which drugs they cover, how much you pay, and which pharmacies you can use. You can enroll in Part D when you first turn 65, and you can change plans each year during the Annual Enrollment Period.

If you do not enroll in Part D when you first become may be able to access and you go without coverage, you may face a permanent penalty when you do enroll later. The penalty is 1 percent of the national average Part D premium for each month you were without coverage. If you have other creditable drug coverage (such as from an employer or union), you may be able to delay Part D without penalty.

Frequently Asked Questions

Do I have to use Original Medicare or can I choose Medicare Advantage instead?

You can choose either one when you first turn 65. Original Medicare gives you access to any doctor or hospital nationwide with no network. Medicare Advantage usually has lower premiums and out-of-pocket limits but restricts you to a network of providers. You pick one at enrollment and can switch during the Annual Enrollment Period each October through December.

What happens if I see a doctor who does not accept Medicare?

You will have to pay the full cost out of pocket. Original Medicare covers care only from providers who accept Medicare. Before you schedule an appointment, ask the office if they accept Medicare. You can also search for Medicare providers on the Medicare.gov provider search tool.

Does Original Medicare cover dental, vision, or hearing?

No. Original Medicare does not cover routine dental care, eyeglasses, hearing aids, or routine eye exams. Some preventive services like screening for glaucoma are covered, but most vision and hearing care is not. You can buy standalone dental, vision, or hearing coverage through private insurers if you want it.

Can I get a Medigap policy if I already have Original Medicare?

Yes. You can buy a Medigap policy at any time, though it is easiest and cheapest to buy one within six months of enrolling in Part B. After that window, insurance companies can charge more or deny coverage based on your health history, depending on your state. Medigap policies are standardized, so the same plan letter (like Plan G) covers the same benefits regardless of which company sells it.

What is the difference between Original Medicare and Medigap?

Original Medicare is the government program itself. Medigap is a private supplemental policy that works alongside Original Medicare to cover costs that Medicare does not pay — like deductibles, coinsurance, and copayments. You have both at the same time. Medicare Advantage is different: it replaces Original Medicare entirely with a private plan.