Original Medicare | ABC Medicare Plans Broker

Medicare Explained

Medicare is the United States Federal health insurance program for people who are 65 or older. It is also available for certain people younger than 65 with disabilities or people with End-Stage Renal Disease. There are several parts to Medicare that contain different coverage.

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B helps cover services from doctors, and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), and many preventive services (like screenings, shots or vaccines, and yearly “wellness” visits)

Medicare Part A

With Medicare Part A, patients receive coverage for inpatient hospital stays, hospice care, care received at a skilled nursing facility, and home health care (in limited situations).

You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
The hospital or facility accepts Medicare.
In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital.

The monthly premium is $0 (2026) if you or your spouse paid Medicare taxes long enough while working, generally at least 10 years (40 quarters).
If you don’t qualify for a premium-free Part A, you might be able to buy it. In 2026, the premium is either $311 or $565 each month, depending on how long you or your spouse worked and paid Medicare taxes. You also have to sign up for Part B to buy Part A. If you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty.

$1,736 (2026) deductible for each benefit period.
Days 1–60: $0 (2026) coinsurance for each benefit period.
Days 61–90: $434 (2026) coinsurance per day of each benefit period.
Days 91 and beyond: $868 (2026) coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
Beyond lifetime reserve days : all costs.
Your Medicare benefits will restart (a new benefit period) after you are out of the hospital for 60 consecutive days.

Medicare Part B

Medicare Part B covers the broadest range of services. There are also specific enrollment windows that you must adhere to in order to prevent facing financial penalties.

Medicare Part B encompasses the bulk of your medical coverage under Medicare, including:

Doctor visits
Outpatient care
Urgent care
Emergency room services
Ambulance services
Durable medical equipment
Preventative Care
Chiropractic adjustments
Mental health services
Non-self-administered medications

The monthly premium for Part B is typically $202.90 (2026). You’ll pay a higher premium if your modified adjusted gross income, as reported on your IRS tax return from 2 years ago, was more than:

$109,000 in 2024, if you file an individual tax return or are married and file separately
$218,000 in 2024 if you are married and file a joint tax return.

Social Security will tell you if you have to pay a higher premium because of your income.

If you qualify for financial help, you may pay a lower premium or it may be completely covered if you qualify for certain levels of Medicaid. The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services.

You might pay a penalty if you don’t sign up for Part B when you’re first eligible for Medicare (usually when you turn 65).

You’ll pay an extra 10% for each year you could have signed up for Part B, but didn’t.
This penalty is added to your monthly Part B premium.
It’s not a one-time late fee — you’ll pay the penalty for as long as you have Part B.
Generally, you won’t have to pay a penalty if you qualify for a Special Enrollment Period. To qualify, you (or your spouse) must still be working and you must have health coverage based on that job.

Important: To enroll in a Medicare Advantage Plan or a Medicare Supplement, you must continue to be enrolled in Medicare Part A and Part B, and continue to pay the Part B monthly premium.

Enrollment in Medicare Part B is optional, but it is recommended for most Medicare-eligible individuals, especially at the first point of eligibility.

There are exceptions, however, if you are still working in your career and have other employer-provided health insurance. In this situation, delaying enrolling may be in your best interest. You can do so without penalty as long as your employer has at least 20 employees.

It’s recommended to enroll during the initial enrollment period (IEP for short) if you are:

Retired
Self-employed
Without health coverage from your employer

Medicare Options

Original Medicare has gaps in coverage in the form of deductibles and coinsurance that you must pay.
Here are your options to help cover those costs.

Medicare Explained

Medicare Part A

Inpatient Care

Monthly Premium

Your costs with Original Medicare Part A

Medicare Part B

What Does Medicare Part B Cover?

Monthly Premium

Your costs with Original Medicare Part B

Should You Enroll in Medicare Part B?

Original Medicare has gaps in coverage in the form of deductibles and coinsurance that you must pay.
Here are your options to help cover those costs.

Medicare Explained

Medicare Part A

Inpatient Care

Monthly Premium

Your costs with Original Medicare Part A

Medicare Part B

What Does Medicare Part B Cover?

Monthly Premium

Your costs with Original Medicare Part B

Should You Enroll in Medicare Part B?

Original Medicare has gaps in coverage in the form of deductibles and coinsurance that you must pay. Here are your options to help cover those costs.

Original Medicare has gaps in coverage in the form of deductibles and coinsurance that you must pay.
Here are your options to help cover those costs.