Medicare Parts A & B - Original Medicare

Original Medicare is comprised of two parts — Part A and Part B.

Original Medicare does not cover 100% of the costs of your medical care for covered services. In fact, it covers only about 80% of the costs and does not cover your prescription drug costs. You must purchase a Medicare Part D plan for prescription drug coverage.

What Part A Covers: Hospital InsuranceWhat Part B Covers: Doctor Insurance
  • Hospitals
  • Skilled nursing facility
  • Hospice
  • Home health
  • Physician services - even when you’re in the hospital
  • Outpatient care
  • Lab services
  • Other medical services

Part A

For most people, Part A does not have a monthly premium. You pay no premium if you or your spouse paid Medicare taxes while working for at least 10 years (or 40 quarters).

Part A coverage can be purchased if you don't qualify. Contact your local Social Security office for more information on purchasing Part A coverage.

You can also use Medicare’s eligibility tool to see if you will need to pay for Part A coverage.

What Medicare Part A does NOT Cover
  • $1,288 inpatient hospital deductible
  • $322 a day copayment for hospital days 61-90
  • $644 a day copayment for hospital days 91-150 (also called Lifetime Reserve Days?)
  • 100% of costs for each day of a stay beyond 150 days
  • $161 a day for days 21-100 in a skilled nursing facility

Part B

There is a monthly premium for Part B coverage. For most people, the premium is $121.80, but can be more expensive based on your income and tax-filing status. Only about 5% of Medicare beneficiaries are required to pay more for Part B. Social Security has more information on the rules for higher-income beneficiaries .

Just like Part A, there are costs that Part B does not cover.

What Medicare Part B does NOT Cover
  • The $166 Part B deductible. Medicare does not start paying for Part B services until this deductible is met.
  • 20% of outpatient charges
  • $644 a day copayment for hospital days 91-150 (also called Lifetime Reserve Days?)
  • 100% of charges over Medicare assignment

NOTE: These are 2016 Medicare Part A and Part B rates. Rates are subject to change each year.