Medicare Parts A and B are where health coverage starts for most people at age 65. Together, they are called Original Medicare, and they cover a large share of hospital and medical care. They do not cover everything, though, and there is no yearly limit on what you can owe out of pocket.
This guide explains what each part covers, what it costs in 2026, and how to decide whether it’s enough on its own. By the end, you will know where your gaps are and what your options look like.
What Is Medicare Part A and Part B?
| Direct answer: Medicare Part A is hospital insurance that helps pay for inpatient stays, skilled nursing facility care, hospice, and some home health care. Part B is medical insurance that helps pay for doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. Together they make up Original Medicare. |
The federal government runs both parts, and each covers a different side of your care. Neither one pays every dollar of a covered service, so you can expect deductibles and coinsurance along the way. Prescriptions you fill at a pharmacy usually require separate coverage.
Part A (hospital insurance) is premium-free for most people. Part B (medical insurance) costs $202.90 a month in 2026 for most beneficiaries. Part D (prescription insurance), Medicare Supplement (Medigap), and Medicare Advantage are separate choices you make once Original Medicare is in place. Our overview of what Medicare is breaks down each part.
Medicare Part A vs. Part B
The two parts work together, but they are not interchangeable. This table lays them side by side.
| Feature | Medicare Part A | Medicare Part B |
|---|---|---|
| Type of coverage | Hospital insurance | Medical insurance |
| Primary focus | Inpatient care | Outpatient and physician care |
| Common services | Hospital stays, skilled nursing, hospice | Doctor visits, outpatient procedures, preventive care |
| Premium | Free for most people | Monthly premium for nearly everyone |
| Deductible | Charged per benefit period | Charged once per year |
| Typical cost sharing | Deductible plus daily coinsurance on longer stays | Usually 20% after the deductible |
| Enrollment | Often automatic | Automatic for some, active sign-up for others |
| Part of Original Medicare | Yes | Yes |
What Does Medicare Part A Cover?
Part A mostly covers care you get as an admitted hospital patient. That includes inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice care, some home health care, and drugs given during a covered inpatient stay.
The coverage has limits. Part A does not pay for unlimited days, and skilled nursing care is not the same as long-term custodial care, which Original Medicare does not cover. A deductible applies to each benefit period, and daily coinsurance starts during longer stays.
One detail catches people off guard. If a hospital keeps you for observation instead of admitting you, Medicare may treat it as outpatient care under Part B, which changes what you owe.
What Does Medicare Part B Cover?
Part B covers the outpatient and physician side of your care. That includes doctor and specialist visits, outpatient procedures, preventive screenings, diagnostic and lab tests, ambulance service, durable medical equipment, mental health care, therapy, and certain drugs a provider gives you in the office.
Part B doesn’t cover every service, and it comes with ongoing cost sharing. You pay an annual deductible, and after that you typically owe 20% of the Medicare-approved amount for most covered services, with no cap under Original Medicare.
Whether a provider accepts Medicare assignment also affects your cost. Our guide on who submits your bills to Medicare walks through the billing side.
How Much Do Medicare Parts A and B Cost?
The figures below reflect 2026 amounts. Medicare updates them each year, so confirm the current numbers before you decide.
| Cost | 2026 Amount and How It Works |
|---|---|
| Part A premium | $0 for most people, based on work history. Others pay $311 or $565 a month. |
| Part A deductible | $1,736 per benefit period |
| Part A hospital coinsurance | $434 a day for days 61 through 90, then $868 a day for lifetime reserve days |
| Skilled nursing coinsurance | $217 a day for days 21 through 100 |
| Part B premium | $202.90 a month for most people, higher at upper incomes |
| Part B deductible | $283 a year |
| Part B coinsurance | Usually 20% of the Medicare-approved amount |
| Annual out-of-pocket maximum | None under Original Medicare alone |
Because you can enter more than one benefit period in a year, it is possible to owe the Part A deductible more than once. For billing and payment options, see our guide on how to pay for Medicare.
Is Medicare A and B Enough Coverage?
| Direct answer: For some people, yes. Original Medicare can be enough if you can comfortably absorb the deductibles, the 20% coinsurance, and other uncovered costs. It has no annual out-of-pocket limit, though, and it does not cover most retail prescriptions, routine dental, routine vision, hearing aids, or long-term care. Many people add coverage to fill those gaps. |
Whether Original Medicare is enough depends on your numbers and habits. Weigh your savings and retirement income, how often you expect to need care, the prescriptions you take, and how well you could handle a surprise medical bill. Your dental, vision, and hearing needs matter too, along with how much you travel and whether you already have employer, retiree, or Medicaid coverage. None of this makes extra coverage mandatory. It just helps you see where you stand.
What Are the Biggest Gaps in Original Medicare?
| Direct answer: Original Medicare generally does not cover retail prescriptions, routine dental, routine vision, hearing aids, long-term custodial care, or most care outside the United States. It also has no annual out-of-pocket maximum, so your share of covered costs can keep adding up. |
No Annual Out-of-Pocket Maximum
Original Medicare does not cap what you pay in Part A and Part B cost sharing each year. If you need a lot of care, your share of the bill can keep climbing with no ceiling. That uncertainty is the single biggest reason people look at extra coverage.
The 20% Part B Coinsurance
After you meet the Part B deductible, you generally owe 20% of the approved amount for covered services, with no dollar limit. On routine visits, that is manageable. On a run of outpatient treatments, chemotherapy, or ongoing therapy, it adds up quickly.
Hospital and Skilled Nursing Cost Sharing
Part A charges a deductible for each benefit period, and you could face more than one benefit period in a single year. Longer stays bring daily coinsurance, and long-term custodial care is not covered at all.
Limited Prescription Drug Coverage
Part A may cover drugs during an inpatient stay, and Part B covers a narrow set of provider-administered drugs. Neither covers the medications you pick up at a pharmacy. For that, you need a Part D plan or a Medicare Advantage plan with drug coverage. Our article on medications covered under Parts A and B goes into more detail.
Limited Dental, Vision, and Hearing Coverage
Original Medicare generally does not pay for routine dental exams, cleanings, or dentures. It also skips routine eye exams for glasses, most eyeglasses and contacts, hearing aids, and the fittings that go with them. Narrow exceptions apply when a service is medically necessary and tied to a covered treatment.
Limited Coverage Outside the United States
Original Medicare rarely covers care outside the country, aside from a few limited exceptions. Some Medigap plans add a foreign travel emergency benefit, which matters if you spend time abroad.
Not sure whether Parts A and B leave you with too much financial exposure? Talk with a Medicare Guide before you choose additional coverage.
Original Medicare Cost Example
If someone has only Parts A and B for the year, they pay the monthly Part B premium year-round. A hospital stay triggers the Part A deductible. Outpatient follow-up care means they meet the Part B deductible, then pay 20% of the approved amount for each service. They cover most of their pharmacy prescriptions on their own, and they pay out of pocket for a dental visit and a hearing check.
In a case like that, Original Medicare still picks up a large share of the total bill. It just does not cover all of it. Actual costs depend on the care you receive, whether your providers accept assignment, and the Medicare amounts in effect that year.
Who Might Be Comfortable With Medicare A and B Only?
Original Medicare on its own can work for people who have a financial cushion or other coverage behind them. That includes those with substantial savings who are comfortable with uncapped cost sharing, people who also have Medicaid, and those with employer or retiree coverage that pays after Medicare. It also fits many people with TRICARE for Life or another form of qualifying secondary coverage.
Most people still need Part D unless they already have creditable drug coverage, and low medical use today does not remove the risk of a costly year later.
Who May Want Additional Medicare Coverage?
Extra coverage tends to appeal to people who want more predictable medical costs. That includes anyone worried about the open-ended 20% coinsurance, people without secondary coverage from an employer or retiree plan, and those who take regular prescriptions.
It also draws people who want a yearly cap on medical spending, some added dental, vision, hearing, or fitness benefits, or help managing an unexpected bill. Frequent travelers often land here too. Treat it as a personal budget and risk decision, not a rule that applies to everyone.
What Can You Add to Medicare Parts A and B?
Medicare Supplement Insurance
A Medicare Supplement (Medigap) policy works alongside Original Medicare and can pick up some of the deductibles, coinsurance, and copayments that Parts A and B leave behind. What it pays depends on the standardized plan you pick, and it carries its own monthly premium.
Medigap does not include Part D drug coverage, and your enrollment timing affects both your price and whether you can be turned down. Our Medicare Supplement plans guide breaks down how the plans compare.
Medicare Part D
Part D adds coverage for the prescriptions you fill at a pharmacy. Private insurers approved by Medicare offer these plans, so premiums, deductibles, copays, drug lists, and pharmacy networks vary from plan to plan. In 2026, Part D also caps what you pay out of pocket for covered drugs at $2,100 for the year.
Delaying Part D without other creditable coverage can trigger a lasting penalty. See our Medicare Part D guide for the details.
Medicare Advantage
Medicare Advantage is a different way to get your Part A and Part B benefits, offered through a private plan rather than added on top of Original Medicare like Medicare Supplement/Medigap. These plans include a yearly cap on out-of-pocket costs for covered services, and many bundle in drug coverage.
In exchange, you usually work within a provider network and may need referrals or prior approval. Our comparison of Medicare Advantage and Medicare Supplement lays out the trade-offs.
Employer, Retiree, Medicaid, or Military Coverage
Some people already have coverage that coordinates with Medicare. If that is you, confirm which coverage pays first, whether your drug coverage counts as creditable, whether you still need to enroll in Part B, and whether adding another plan would just duplicate what you have.
Medicare Supplement (Medigap) vs. Medicare Advantage
These are two different paths, and you generally choose one rather than stacking them. The table below shows how they differ.
| Feature | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| How coverage works | Medigap supplements Original Medicare | A private plan delivers your Medicare benefits |
| Provider access | Any provider that accepts Medicare, subject to your policy | Usually limited to the plan’s network |
| Monthly premium | Medigap and Part D premiums may apply | Plan premium varies, and the Part B premium still applies |
| Medical cost sharing | Depends on the Medigap plan | Copays and coinsurance vary by plan |
| Out-of-pocket protection | Medigap can cover many gaps | Yearly cap on covered medical services |
| Prescription drugs | Usually a separate Part D plan | Often included |
| Prior authorization | Less common under Original Medicare | May be required |
| Extra benefits | Typically limited | May include added benefits |
How to Decide If Medicare A and B Are Enough for You
Run through these questions to see where you stand:
- Could I comfortably pay 20% of a large outpatient bill with no ceiling?
- Could I handle more than one Part A deductible in the same year?
- Do I already have creditable prescription drug coverage?
- Do I have employer, retiree, Medicaid, or military coverage that coordinates with Medicare?
- How much do I value seeing any provider who accepts Medicare?
- Would I rather pay steady premiums or pay as I go?
- Do I need routine dental, vision, or hearing benefits?
- Do I travel often, including outside the country?
- Am I still inside my Medigap open enrollment window?
Common Mistakes When Relying on Medicare A and B
- Assuming Medicare pays 100% of approved costs.
- Overlooking the missing annual out-of-pocket cap.
- Forgetting to sign up for prescription drug coverage.
- Mixing up Medicare Advantage and Medicare Supplement.
- Expecting routine dental, vision, and hearing care to be covered.
- Waiting too long to look at Medigap, when underwriting can get harder.
- Choosing coverage on the monthly premium alone.
- Assuming good health now removes future financial risk.
Talk to a Medicare Guide Before Choosing Additional Coverage
Choosing coverage around Original Medicare is a lasting decision you don’t have to face alone. A Medicare Guide can help you:
- Review the costs Parts A and B leave behind.
- Compare Medicare Supplement and Medicare Advantage side by side.
- Check your prescriptions, doctors, and enrollment timing.
- Get educational, no-pressure guidance built around you.
Not sure whether Medicare Parts A and B give you enough coverage? Contact Medicare School to talk with a Medicare Guide before you choose your next step.
Frequently Asked Questions
What is the difference between Medicare Part A and Part B?
Part A covers hospital care, skilled nursing, hospice, and some home health. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment. Together, they are Original Medicare.
Is Medicare Parts A and B enough coverage?
It can be, for people who can absorb the deductibles and the 20% coinsurance and who have creditable drug coverage. Others add a plan to cap their costs and fill gaps like dental and vision.
Does Medicare Parts A and B cover 100% of medical costs?
No. After deductibles, you generally pay 20% of the approved amount for Part B services, and Original Medicare has no annual out-of-pocket limit.
What does Original Medicare not cover?
It generally does not cover retail prescriptions, routine dental, routine vision, hearing aids, long-term custodial care, or most care outside the United States.
Does Medicare Parts A and B have an out-of-pocket maximum?
No. Part A and B alone have no yearly cap on what you can owe. A Medicare Supplement/Medigap plan or Medicare Advantage plan can add that protection.
Does Medicare Parts A and B cover prescriptions?
Only in narrow cases, such as drugs given during a hospital stay or certain drugs a provider administers. Prescription drugs require Part D or a Medicare Advantage plan with drug coverage.
Do I need Part D if I have Medicare Parts A and B?
Usually. Without Part D or other creditable coverage, you have no real prescription coverage and may owe a late enrollment penalty later.
Do I need Medicare Supplement/Medigap if I have Medicare Parts A and B?
It is not required, but many people choose it. Medigap helps pay the deductibles and coinsurance that Parts A and B leave behind.
What is the 20% that Medicare does not cover?
It is the share of the Medicare-approved amount you typically owe for Part B services after the deductible. There is no dollar cap on it under Original Medicare alone.
How much do Medicare Parts A and B cost in 2026?
The standard Part B premium is $202.90 a month with a $283 annual deductible. For most people, Part A is premium-free with a $1,736 deductible per benefit period.