Medicare has multiple parts and each covers something different. Here’s a plain-language breakdown of what Part A and Part B actually cover, what they cost, and where the gaps are.
Part A (Hospital)
$0 Premium
For most people with 40+ work quarters
Part B (Medical)
$202.90/mo
Standard 2026 premium (may be higher with IRMAA)
Coverage Gap
20%
What you owe on most Part B services after the deductible
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people don’t pay a monthly premium for Part A because they (or their spouse) paid Medicare taxes for at least 40 quarters (10 years) while working.
| What Part A Covers | 2026 Cost to You |
|---|---|
| Inpatient hospital stay (days 1–60) | $1,736 deductible per benefit period |
| Inpatient hospital stay (days 61–90) | $434/day coinsurance |
| Inpatient hospital stay (days 91+) | $868/day (lifetime reserve days) |
| Skilled nursing facility (days 1–20) | $0 |
| Skilled nursing facility (days 21–100) | $217/day |
| Hospice care | $0 for most services |
| Home health care (if eligible) | $0 |
Part B covers doctor visits, outpatient services, preventive care, lab tests, durable medical equipment, and some home health services. Unlike Part A, Part B requires a monthly premium from everyone enrolled.
| What Part B Covers | 2026 Cost to You |
|---|---|
| Annual Part B deductible | $283 (you pay this first) |
| Doctor visits and outpatient services | 20% after deductible (no cap) |
| Preventive services (annual wellness visit, screenings) | $0 (no deductible or coinsurance) |
| Durable medical equipment | 20% after deductible |
| Mental health services (outpatient) | 20% after deductible |
| Ambulance services | 20% after deductible |
Part B (and Part D) carry permanent late penalties if you delay without other qualifying coverage. Use the 2026 figures to see what waiting would add to your premium.
The Part B penalty adds 10% of the standard premium ($202.90 in 2026) for each full 12-month period you were eligible but didn't enroll (without other job-based coverage).
Optional: fill these to auto-calculate your months late, or just type the number below.
$0.00
Estimated monthly penalty added to your Part B premium
Enter your months above to see your estimated penalty.
The Part D penalty adds 1% of the national base premium ($38.99 in 2026) for every full month you went without Part D or other creditable drug coverage (a gap of 63+ days).
Optional: fill these to auto-calculate your uncovered months, or just type the number below.
$0.00
Estimated monthly penalty added to your Part D premium
Enter your months above to see your estimated penalty.
Original Medicare (Parts A and B) has significant gaps. Understanding what isn’t covered is just as important as knowing what is:
Not covered by Original Medicare: Routine dental, vision, and hearing care, Prescription drugs (requires Part D or MAPD), Long-term care / nursing home custodial care, Cosmetic procedures, Most care received outside the United States
The most significant financial gap in Original Medicare is the unlimited 20% coinsurance under Part B. There is no cap, if you have a $200,000 surgery, your 20% share is $40,000. This is the core reason most people on Original Medicare add either a Medigap plan or Medicare Advantage.
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