A clear breakdown of Medicare Part A (hospital insurance) and Part B (medical insurance) - what each covers, what they cost, and when to enroll.
In This Article
Hospital, skilled nursing, hospice.
Doctor visits, outpatient, preventive.
Premiums, deductibles, coinsurance.
Initial enrollment and special periods.
Penalties and how to avoid them.
The gaps you need to know about.
Government and nonprofit references.
Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Medicare Part B covers doctor visits, outpatient care, preventive screenings, and medical equipment. Most people pay $0 for Part A and $185 per month for Part B in 2026.
Key Takeaways
Quick Answer
Medicare Part A covers hospital stays, skilled nursing, hospice, and home health (most people pay $0 in premiums). Part B covers doctor visits, outpatient care, and preventive services ($185/month in 2026). You need both for complete coverage. Neither covers long-term personal care at home.
You turn 65 and suddenly everyone is talking about Part A, Part B, Part C, Part D, Medigap, Medicare Advantage - and you are supposed to just know what all of this means. We get it. We have sat across the table from thousands of people who felt exactly the same way.
Here is the good news - you really only need to understand two pieces to start. Part A and Part B. That is it. Together they make up Original Medicare. Let us break down what each one covers, what you will actually pay in 2026, and how to avoid the penalties that nobody warns you about until it is too late.
Quick Summary
Think of Part A this way: it is the part of Medicare that covers you when something big happens. A hospital stay. A fall that leads to skilled nursing. Hospice care. If you end up somewhere overnight for medical reasons, Part A is paying the bill.
Part A covers four main categories:
When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications given during your stay, lab tests, and surgeries. It does not cover your private-duty nursing or a private room unless medically necessary.
For 2026, here is what you pay for a hospital stay:
A benefit period starts the day you are admitted and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row. If you go back to the hospital after that, a new benefit period starts and you pay the deductible again.
If you need skilled nursing care after a qualifying hospital stay of at least 3 days, Part A covers up to 100 days per benefit period. This is not the same as long-term nursing home care, which Medicare does not cover.
If you have a terminal illness and choose comfort care over curative treatment, Part A covers hospice. This includes nursing care, pain management, counseling, and medication related to your terminal diagnosis. You pay $0 for most hospice services, though there may be a small copay of up to $5 for prescription drugs.
Part A covers home health care when you are homebound and need skilled nursing or therapy on a part-time basis. This can include a visiting nurse, physical therapy, occupational therapy, and some medical supplies. You pay $0 for covered home health services. If you need ongoing home care coordination, understanding your Part A benefits is an important first step.
If Part A is for the big stuff, Part B is for everything else - and honestly, this is where most of your medical spending happens. Your doctor visits, lab work, specialist appointments, preventive screenings. Part B handles all of it.
Part B covers visits to your doctor's office, specialist appointments, outpatient surgeries, diagnostic tests like X-rays and bloodwork, mental health services, and second opinions before surgery. After you meet your annual $257 deductible, you typically pay 20% of the Medicare-approved amount for most services.
One of the biggest benefits of Part B is that many preventive services are covered at no cost to you, with no deductible and no coinsurance. These include:
Here is the thing most people do not realize - these preventive services cost you absolutely nothing. No deductible, no coinsurance. Take advantage of them. Call your doctor's office and schedule your annual wellness visit. It is the best deal in Medicare.
Part B also covers durable medical equipment, often called DME. This includes wheelchairs, walkers, hospital beds for home use, oxygen equipment, and blood sugar monitors. You pay 20% of the Medicare-approved amount after your deductible.
Part B covers ambulance transportation when other transportation would endanger your health. You pay 20% coinsurance after the deductible.
| Cost | Part A (Hospital) | Part B (Medical) |
|---|---|---|
| Monthly premium | $0 for most people (up to $518 if you did not work 10+ years) | $185 per month (standard); higher if income above $106,000 |
| Annual deductible | $1,676 per benefit period | $257 per year |
| Coinsurance | $0 for first 60 days; $419/day for days 61-90 | 20% of Medicare-approved amount |
| Out-of-pocket maximum | No cap | $2,700 new cap starting 2026 |
That $2,700 out-of-pocket cap on Part B is brand new for 2026 - and it is a big deal. Before this year, there was no limit. You could spend $10,000, $20,000, and Medicare would just keep charging you 20%. Now there is a ceiling. What this means for you: if you need a lot of outpatient care or expensive lab work, your costs are capped for the first time ever.
Most people pay $0 in premiums for Part A. You qualify for premium-free Part A if you or your spouse paid Medicare taxes for at least 10 years, which equals 40 quarters of work.
If you do not have enough work credits:
Even though the premium may be $0, Part A still has significant costs when you actually use it. That $1,676 deductible per benefit period can add up, especially if you have multiple hospital stays in one year.
The standard Part B premium for 2026 is $185 per month. This is up from $174.70 in 2025. Most people have this deducted automatically from their Social Security check.
If your modified adjusted gross income is above $106,000 as an individual or $212,000 as a married couple, you pay more. This extra charge is called IRMAA, which stands for Income-Related Monthly Adjustment Amount.
| Individual Income | Married Couple Income | Monthly Part B Premium |
|---|---|---|
| $106,000 or less | $212,000 or less | $185.00 |
| $106,001 to $133,500 | $212,001 to $267,000 | $259.00 |
| $133,501 to $167,000 | $267,001 to $334,000 | $370.00 |
| $167,001 to $200,000 | $334,001 to $400,000 | $480.90 |
| Above $200,000 | Above $400,000 | $591.90 |
If your income has dropped since the tax year Medicare is using, for example because you retired or lost a spouse, you can appeal your IRMAA by filing a life-changing event form with Social Security.
Your Initial Enrollment Period is a 7-month window around your 65th birthday. It starts 3 months before the month you turn 65, includes your birthday month, and extends 3 months after.
If you are already receiving Social Security benefits when you turn 65, you are enrolled in both Part A and Part B automatically. If not, you need to sign up. For official enrollment details, visit medicare.gov.
There are also Special Enrollment Periods if you delayed Medicare because you had coverage through an employer. You get 8 months after that employer coverage ends to sign up without a penalty.
This is the section we wish we did not have to write - but it is one of the most important. Late enrollment penalties are permanent. They do not go away. They follow you for the rest of your life. Read that again.
Part A penalty: If you have to pay a Part A premium and you did not sign up when first eligible, your premium goes up 10%. You pay this higher amount for twice the number of years you delayed.
Part B penalty: Your premium goes up 10% for every full 12-month period you could have had Part B but did not sign up. Waited 3 years? That is a 30% surcharge on your Part B premium. Every month. For the rest of your life. We cannot stress this enough - do not miss your enrollment window.
The General Enrollment Period runs from January 1 through March 31 each year, with coverage starting July 1. If you missed your initial window and do not qualify for a Special Enrollment Period, this is when you can sign up.
Yes. Almost always yes. Here is why this matters in real life.
Say you only have Part A and you break your arm. You go to the emergency room. X-rays, exam, a cast - that is all outpatient. Part B territory. Without Part B, you are paying for all of that yourself. Part A only kicks in if they formally admit you to the hospital.
If you only have Part B and need surgery that requires an overnight hospital stay, you would be responsible for the full cost of the hospital portion of your care.
Together, Part A and Part B form Original Medicare. Many people also add a Part D prescription drug plan and a Medigap supplemental policy to fill in the cost-sharing gaps. Understanding what is and is not covered helps you review your medical bills for errors and avoid surprise charges. A patient advocate can help with billing disputes.
Even with both parts, Original Medicare has notable gaps:
Some Medicare Advantage plans, which are an alternative way to get your Part A and Part B benefits through a private insurer, do include dental, vision, and hearing coverage.
Medicare's split between Part A and Part B confuses almost everyone. This table maps common medical situations to the correct part of Medicare.
| Scenario | Part A or Part B? | What Medicare Pays |
|---|---|---|
| You break your hip and need surgery | Part A (hospital stay) + Part B (surgeon's fee) | Part A covers the room. Part B covers the doctor. |
| You visit your doctor for a checkup | Part B | 100% for most preventive visits. 80% for diagnostic. |
| You need a CT scan at an imaging center | Part B | 80% after deductible. You pay 20%. |
| You are admitted to a skilled nursing facility after hospital | Part A | 100% for days 1-20. Coinsurance for days 21-100. |
| You need home health care after surgery | Part A (if homebound) or Part B | 100% for skilled nursing and therapy. 80% for equipment. |
| You need an ambulance to the ER | Part B | 80% after deductible. |
| You receive chemotherapy at an outpatient clinic | Part B | 80% after deductible. You pay 20%. |
| You are in the hospital as an outpatient (observation status) | Part B (not Part A!) | 80%. This is a costly surprise for many patients. |
| You enter hospice care | Part A | Nearly 100%. Small copays for drugs and respite care. |
| You need a wheelchair or oxygen equipment | Part B (DME) | 80% after deductible for approved equipment. |
The observation status trap: If you are in a hospital bed but classified as "outpatient observation" instead of "admitted," Part A does not apply. You pay Part B coinsurance for the hospital stay, and the stay does not count toward the 3-day requirement for skilled nursing facility coverage. Always ask your hospital whether you are admitted or under observation.
These are the official 2026 costs published by the Centers for Medicare & Medicaid Services (CMS).
| Cost | Part A | Part B |
|---|---|---|
| Monthly Premium | $0 for most (if 40+ work quarters). Up to $518 if not. | $185/month standard. Higher if income exceeds $106,000 (IRMAA). |
| Annual Deductible | $1,676 per benefit period | $257 per year |
| Coinsurance | $0 for days 1-60. $419/day for days 61-90. $838/day lifetime reserve. | 20% of Medicare-approved amount after deductible. |
| Out-of-Pocket Maximum | No cap (Original Medicare has no OOP max) | No cap (Original Medicare has no OOP max) |
Important: Original Medicare (Part A + Part B) has no out-of-pocket maximum. This is why many beneficiaries add a Medigap supplement plan or switch to Medicare Advantage (Part C), which is required to cap your annual costs.
Missing your enrollment window for Part B can cost you permanently. Here are the three windows you need to know.
Initial Enrollment Period (IEP)
When: 7-month window around your 65th birthday (3 months before, birth month, 3 months after)
Best option. No penalties. Coverage starts the month you turn 65 if you enroll during the first 3 months.
General Enrollment Period (GEP)
When: January 1 - March 31 each year. Coverage starts July 1.
Late penalty applies. 10% added to your Part B premium for each 12-month period you could have enrolled but did not.
Special Enrollment Period (SEP)
When: Available if you delayed because of employer coverage. 8-month window after employer coverage ends.
No penalty. Must have had continuous employer coverage to qualify.
The penalty is permanent. If you delayed Part B for 2 years without qualifying employer coverage, you pay 20% more on your Part B premium for the rest of your life. At the 2026 standard rate, that is an extra $37/month - or $444/year - forever.
Original Medicare (Part A + Part B) leaves significant gaps. Understanding these gaps is critical for planning your healthcare costs.
| Service | Covered by Part A/B? | How to Get Coverage |
|---|---|---|
| Dental (cleanings, fillings, dentures) | No | Medicare Advantage (many plans include it), standalone dental plan, or pay out of pocket |
| Vision (eyeglasses, contacts, routine exams) | No (Part B covers glaucoma tests and cataract surgery) | Medicare Advantage or standalone vision plan |
| Hearing Aids | No (Part B covers diagnostic hearing exams) | Medicare Advantage or out of pocket ($1,000 - $6,000 per pair) |
| Prescription Drugs | No (only Part B drugs administered by a doctor) | Part D plan or Medicare Advantage with drug coverage |
| Long-Term Care (nursing home, assisted living) | No (Part A covers skilled nursing up to 100 days only) | Medicaid (if eligible), long-term care insurance, or private pay |
| Overseas Healthcare | No (except limited ER in Canada) | Travel insurance or Medigap plans C, D, F, G, M, N |
For New York residents who qualify for both Medicare and Medicaid (dual-eligible), programs like CDPAP can fill the long-term care gap by providing paid home caregivers at no cost to the patient.
Key Takeaway
Part A covers hospital stays and is usually free. Part B covers doctor visits and costs $185 per month in 2026. You need both for full coverage. Sign up during your Initial Enrollment Period to avoid late penalties.
For most people, yes. If you or your spouse worked and paid Medicare taxes for at least 10 years, you pay $0 in premiums for Part A. You still have out-of-pocket costs like the $1,676 deductible when you use hospital services, but the monthly premium itself is $0.
Yes, you can enroll in Part A only. Some people do this if they still have employer coverage that handles their outpatient and doctor visit needs. However, if you delay Part B past your Initial Enrollment Period without qualifying coverage, you will face a permanent late enrollment penalty when you do sign up.
Original Medicare is Part A plus Part B administered by the federal government. Medicare Advantage (Part C) is offered by private insurers - it must cover everything Original Medicare covers but often adds dental, vision, and drugs, with the tradeoff of requiring in-network providers.
Part B covers a small number of drugs administered by a doctor, such as chemotherapy infusions or certain injections given in a medical office. It does not cover prescriptions you fill at a pharmacy. For that, you need a separate Part D prescription drug plan. If medication costs are a concern, ask your pharmacist about generic alternatives or visit medicare.gov to compare Part D plans.
The general rule is simple. Part A covers care where you are an admitted inpatient at a facility. Part B covers outpatient services and doctor visits. If you go to the emergency room but are not formally admitted, that visit falls under Part B. If you are admitted to the hospital from the emergency room, the hospital stay falls under Part A. Your Medicare Summary Notice will show which part was billed for each service.
Key Takeaways
Government agencies, nonprofit organizations, and trusted institutions with additional information on topics covered in this article.