What Is Original Medicare?
Original Medicare is the federal health insurance program for people 65 and older. It has two parts — Part A (hospital) and Part B (medical). Understanding what it covers, what it costs, and what it leaves behind is the foundation of every smart Medicare decision.
2026 Medicare Costs — Official
Source: CMS.gov — November 14, 2025
Medicare Part A & Part B — 2026
Original Medicare has two parts. Most people get Part A premium-free. Part B has a monthly premium everyone pays.
Medicare Part A — Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. About 99% of Medicare beneficiaries receive Part A premium-free because they (or their spouse) worked and paid Medicare taxes for at least 40 quarters (10 years).
| Part A Cost in 2026 | Amount |
|---|---|
| Premium (40+ quarters) | $0/month |
| Premium (30–39 quarters) | $311/month |
| Premium (<30 quarters) | $565/month |
| Hospital deductible (per benefit period) | $1,736 |
| Days 1–60 coinsurance | $0 |
| Days 61–90 coinsurance | $434/day |
| Lifetime reserve days | $868/day |
| Skilled nursing days 21–100 | $217/day |
The Part A deductible of $1,736 applies per benefit period — not per year. If you are readmitted to the hospital 60+ days after discharge, a new benefit period begins and you owe the full $1,736 again. There is no annual cap.
Medicare Part B — Medical Insurance
Part B covers doctors' services, outpatient care, preventive services, lab tests, medical equipment, and some home health services. Everyone enrolled in Part B pays a monthly premium regardless of income — higher-income beneficiaries pay more (IRMAA).
| Part B Cost in 2026 | Amount |
|---|---|
| Standard monthly premium | $202.90/mo |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% |
| Annual out-of-pocket maximum | None — unlimited |
| IRMAA starts at (individual) | $109,000 MAGI |
| IRMAA starts at (joint) | $218,000 MAGI |
Part B pays 80% of approved costs after the deductible. You pay 20% — with no annual maximum. A $200,000 hospital and surgery bill means you owe $40,000 in Part B coinsurance alone. This is why most Medicare beneficiaries add a Supplement or Advantage plan.
The Coverage Gaps Most People Don't Know About
Original Medicare was not designed to cover everything. These gaps are why most beneficiaries add supplemental coverage.
What You Can Add to Original Medicare
- No network — any Medicare provider
- Near-zero out-of-pocket with Plan G
- Add a separate Part D for drugs
- Often $0 monthly premium
- Dental, vision, hearing often included
- Part B Giveback available in Utah
- $2,100 out-of-pocket cap in 2026
- Compared against your actual Rx
- Permanent penalty for late enrollment
When You Must Enroll in Medicare
Missing your enrollment window can result in permanent, lifelong penalties. Here are the key deadlines.
Initial Enrollment Period
7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after. Enroll in Part B during the 3 months before your birthday for a smooth coverage start.
Starts 3 months before 65Special Enrollment Period
If you have employer coverage through active employment at 65, you can delay Medicare without penalty. When that coverage ends, you have 8 months for Part B and 63 days for Part D to enroll without penalty.
Employer coverage = delay OKLate = Permanent Penalty
Miss your window without qualifying coverage: Part B penalty = 10% per year late, forever. Part D penalty = 1% per month late, forever. These never go away. Brian helps you avoid them.
⚠️ Permanent — avoid at all costsMedicare Is Complex. Brian Makes It Simple.
Free 30-minute review. Brian explains your options in plain English, compares every plan in your area, and handles enrollment. No cost, no pressure.