Traditional Medicare is the federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS) for people 65 and older

It is not one insurance plan — it is two separate parts that work together. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and medical equipment. You pay premiums for Part B, and most people pay nothing for Part A if they or their spouse paid Medicare taxes for at least 10 years while working.

The program is "traditional" because it is the original Medicare structure, as opposed to Medicare Advantage (Part C), which is an alternative way to receive the same benefits through a private insurance company. With traditional Medicare, you go to any doctor or hospital that accepts Medicare — there is no network restriction, though you will pay more if you see an out-of-network provider.

You become may be able to access to enroll at 65. If you do not sign up when you first become may be able to access, you will pay a permanent penalty on your premiums for as long as you have Medicare, unless you had other health coverage through an employer or a spouse's employer.

Key Takeaways

  • Traditional Medicare has two main parts: Part A covers hospitals and skilled nursing, Part B covers doctors and outpatient services, and you can see any provider who accepts Medicare.
  • Most people pay no premium for Part A but do pay a monthly premium for Part B, plus deductibles and coinsurance when you use services.
  • Traditional Medicare does not cover dental, vision, hearing aids, or long-term custodial care, so many people add a Medigap or Part D plan to fill gaps.
  • You must enroll at 65 or during a special enrollment period, or you will face a permanent penalty added to your premiums.
  • You can switch from traditional Medicare to Medicare Advantage or vice versa during the annual enrollment period from October 15 to December 7.

What Part A and Part B Cover

Part A covers inpatient hospital care, including room, meals, and standard nursing care. It also covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, and it covers hospice care for people with a terminal illness. Part A does not cover custodial care — help with bathing, dressing, or eating — unless it is part of skilled nursing care you need for a medical reason.

Part B covers doctor office visits, preventive care (like annual wellness visits and cancer screenings), lab tests, X-rays, and durable medical equipment such as wheelchairs or oxygen. It also covers mental health services, physical therapy, and ambulance transport. Part B does not cover routine dental work, eyeglasses, hearing aids, or most prescription drugs (those are covered under Part D, a separate plan you add).

Both parts have a deductible you pay before Medicare starts to pay. For 2024, Part A has a deductible of $1,632 per hospital stay, and Part B has a deductible of $240 per year. After you meet the deductible, you typically pay 20 percent of the cost of services, and Medicare pays 80 percent. These amounts change each year.

Costs: Premiums, Deductibles, and Out-of-Pocket Limits

Most people pay no monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. If you do not meet that requirement, you can still enroll and pay a premium — the amount depends on how many years you or your spouse paid Medicare taxes.

Part B has a monthly premium that most people pay directly from their Social Security check. The standard premium for 2024 is $164.90 per month, but it is higher if your income is above a certain threshold. The income limits change each year, and higher earners pay more.

Traditional Medicare has no annual out-of-pocket limit, which means your costs can grow without bound if you have a serious illness or injury. This is a major difference from Medicare Advantage plans, which do have an annual limit. Many people buy a Medigap policy (also called supplemental insurance) to cover the deductibles and coinsurance that traditional Medicare does not pay. Medigap premiums vary by plan and location but typically range from $100 to $300 per month.

What Traditional Medicare Does Not Cover

Traditional Medicare has significant gaps. It does not cover dental care, routine eye exams, eyeglasses, or hearing aids — even though these are common needs for older adults. It does not cover long-term custodial care in a nursing home or assisted living facility, which can cost thousands of dollars per month. It does not cover most prescription drugs, though you can add Part D coverage for a separate premium.

It also does not cover routine foot care, most acupuncture, or cosmetic surgery. Travel outside the United States is not covered, except in limited circumstances in Canada and Mexico. If you need services that traditional Medicare does not cover, you pay the full cost yourself unless you have supplemental insurance or a separate plan that covers it.

How to Enroll and When Enrollment Periods Happen

You can enroll in traditional Medicare starting three months before the month you turn 65. The enrollment window is seven months long — three months before, the month you turn 65, and three months after. If you miss this window and do not have other health coverage through an employer, you will pay a permanent 10 percent penalty on your Part B premium for each year you were may be able to access but not enrolled.

You enroll through Social Security (online at ssa.gov, by phone at 1-800-772-1213, or in person at a local Social Security office), through Medicare.gov, or by calling 1-800-MEDICARE. You will need your Social Security number and information about any current health coverage.

If you are still working and covered by an employer plan, you may be able to delay enrollment without penalty. Ask your employer's benefits office whether you may have access to for a special enrollment period, which lets you enroll later without the penalty.

Traditional Medicare Versus Medicare Advantage

The main difference is how the insurance works. With traditional Medicare, the federal government is your insurer — you can see any doctor or hospital that accepts Medicare, and there is no network. With Medicare Advantage (Part C), a private insurance company is your insurer, and you typically must use doctors and hospitals in their network, though you may have lower out-of-pocket costs.

Traditional Medicare has no annual out-of-pocket limit, so your costs can be very high if you have serious health needs. Medicare Advantage plans have an annual limit, usually $7,550 or less. However, Medicare Advantage plans often have higher copays for each doctor visit or service, and they may require prior authorization before you can see a specialist or have a procedure.

You can switch between traditional Medicare and Medicare Advantage during the annual enrollment period from October 15 to December 7 each year. Changes take effect on January 1. If you switch to Medicare Advantage and then want to go back to traditional Medicare, you can do so, but you may not be able to buy a Medigap policy without medical underwriting, which means the insurance company can charge you more or deny coverage based on your health.

Adding Prescription Drug Coverage and Supplemental Insurance

Traditional Medicare does not cover prescription drugs. You must add Part D (prescription drug coverage) through a private insurance company if you want this coverage. Part D plans vary widely in cost and which drugs they cover. You can enroll in Part D when you first become may be able to access for Medicare, or during the annual enrollment period. If you go without Part D coverage and later enroll, you will pay a permanent penalty on your premiums.

Many people also buy a Medigap policy to cover the deductibles, coinsurance, and copays that traditional Medicare leaves you responsible for. Medigap is sold by private insurance companies and comes in 10 standardized plans, labeled A through N. Each plan covers a different combination of costs. You can enroll in Medigap when you first become may be able to access for Part B, and you have a six-month window to enroll without medical underwriting. After that window closes, the insurance company can charge you more or deny coverage based on your health.

Frequently Asked Questions

Do I have to enroll in traditional Medicare at 65?

No, but if you do not enroll and do not have other health coverage through an employer or a spouse's employer, you will pay a permanent penalty on your Part B premium. The penalty is 10 percent for each year you were may be able to access but not enrolled. If you are still working and covered by an employer plan, ask your benefits office whether you can delay enrollment without penalty.

Can I see any doctor with traditional Medicare?

You can see any doctor or hospital that accepts Medicare. There is no network restriction. However, if you see a provider who does not accept Medicare assignment (meaning they do not agree to the Medicare-approved fee), you may pay more out of pocket. You can check whether a provider accepts Medicare on Medicare.gov.

What happens if I cannot afford the premiums and deductibles?

You may be able to get help through Medicaid (if your income is low enough), the Medicare Savings Program (which helps pay premiums and deductibles), or the Low-Income Subsidy program (which helps pay for Part D). Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.

Can I switch from traditional Medicare to Medicare Advantage?

Yes, during the annual enrollment period from October 15 to December 7. You can also switch back to traditional Medicare during this period, but if you do, you may not be able to buy a Medigap policy without medical underwriting, which means the insurance company can charge you more or deny coverage based on your health.

Does traditional Medicare cover nursing home care?

Traditional Medicare covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, but only for skilled care related to your hospital stay. It does not cover custodial care — help with daily living — in a nursing home or assisted living facility. Long-term care insurance or Medicaid may cover these costs, depending on your income and assets.