Original Medicare refers to the federal health insurance program funded by the government for individuals 65 and older, as well as for certain people of any age with disabilities, permanent kidney failure (ESRD), or ALS (amyotrophic lateral sclerosis).

Original Medicare consists of two parts: Part A (hospital insurance) and Part B (medical insurance).

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Most people do not need to pay a premium for Part A, as they have already paid into the Medicare system through payroll taxes while working.

Medicare Part B covers medically necessary services, including doctor visits, preventive services, outpatient care, durable medical equipment, and some home health care services. Part B requires a monthly premium ($185 for most people in 2025), which is based on income. Some people may experience a higher premium when the Social Security Administration determines the Income-Related Monthly Adjustment Amount (IRMAA) that needs to be added to the monthly premium.

Original Medicare allows beneficiaries to choose any doctor, hospital, or healthcare provider that accepts Medicare, anywhere in the United States. However, it does not cover all healthcare costs, and individuals may still have out-of-pocket expenses such as deductibles, copayments, and coinsurance.

Many individuals choose to supplement their Original Medicare coverage with a private Medicare Supplement (Medigap) plan, to help cover some of these out-of-pocket costs. Others may choose to receive their Medicare benefits through a Medicare Advantage Plan (also called Part C) administered by private insurance companies.

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What does Medicare Part A cover?

Medicare Part A covers various hospital-related services, such as:

  1. Inpatient Hospital Care: This includes semi-private rooms, meals, general nursing care, medications, and other necessary hospital services and supplies.
  2. Skilled Nursing Facility (SNF) Care: Medicare covers skilled nursing care in a certified SNF if you’ve been in the hospital for three days in a row or more. This can include rehabilitation services, such as physical therapy, occupational therapy, and speech-language pathology services.
  3. Hospice Care: Part A covers hospice care for individuals with a terminal illness, providing pain relief, symptom management, and support services. This can be provided in a hospice facility, hospital, nursing home, or at home.
  4. Home Health Care: Medicare covers part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, and home health aide services. This type of care is typically for individuals who are homebound, and it must be provided by a Medicare-certified home health agency.
While Part A covers these services, it does not cover all associated costs. Deductibles, copayments, and coinsurance may still apply. Additionally, Part A has limitations on the number of days covered for certain services, such as hospital stays and skilled nursing facility care.

How much does Medicare Part A cost?

For most people, Medicare Part A does not require a monthly premium. This is because individuals who have worked and paid Medicare taxes for enough quarters (40 quarters or 10 years) typically receive premium-free Part A coverage. This is often referred to as “premium-free Part A.”

However, if you do not qualify for premium-free Part A, you may still be able to enroll in Part A by paying a monthly premium. The premium amount depends on the number of quarters you have paid Medicare taxes. In 2025, the premium for individuals who have paid Medicare taxes for 30-39 quarters is $285 per month, and for individuals who have paid Medicare taxes for fewer than 30 quarters, the premium is $518 per month.

Even with premium-free Part A, there are still other costs associated with Part A, such as deductibles, coinsurance, and copayments. For example, in 2025, the deductible for each 60-day hospital benefit period is $1,676, and there are coinsurance amounts for hospital stays beyond a certain number of consecutive days (days 61–150).

Check with the official Medicare website medicare.gov to get the most accurate and up-to-date information on the cost of Part A, as it can change from year to year.

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What does Medicare Part B cover?

Medicare Part B covers a wide range of medical services and supplies that are considered medically necessary, such as:
  1. Doctor Visits: This includes visits to doctors, specialists, and other healthcare providers. It covers services such as examinations, consultations, and preventive screenings.
  2. Outpatient Care: Part B covers medically necessary services received in an outpatient setting, such as outpatient surgeries, diagnostic tests, and laboratory services.
  1. Preventive Services: Medicare Part B provides coverage for a variety of preventive services, including vaccinations, screenings for various conditions (such as cancer, diabetes, and cardiovascular diseases), and counseling for certain behavioral and mental health issues.
  2. Durable Medical Equipment (DME): Part B covers medically necessary DME, such as wheelchairs, walkers, oxygen equipment, and other supplies needed for medical purposes.
  3. Ambulance Services: Medicare covers emergency and non-emergency ambulance transportation when it is considered medically necessary.
  4. Outpatient Mental Health Services: Part B covers mental health services received on an outpatient basis, including individual and group therapy, psychiatric evaluations, and medication management.
  5. Home Health Services: Medicare Part B covers certain medically necessary services provided by a Medicare-certified home health agency, including part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, and medical social services.

How much does Medicare Part B cost?

The cost of Medicare Part B can vary depending on several factors, including your income and the year you enroll. Here are the general cost components of Part B:
  1.  Monthly Premium: Most people pay the standard monthly premium for Part B, which is determined by the government each year. The standard premium for 2025 is $185.00. However, higher-income individuals may have to pay an Income-Related Monthly Adjustment Amount (IRMAA), which is an additional amount added to the standard premium.
  2. Deductible: Part B has an annual deductible that you must pay before Medicare starts covering your medical expenses. For 2025, the deductible is $257.
  3. Coinsurance or Copayments: After you meet the deductible, you typically pay 20% of the Medicare-approved amount for most services covered by Part B. There may also be copayments for certain services.
Check with the official Medicare website to get the most accurate and up-to-date information on the cost of Part B, as it can change from year to year.

How do I enroll in Medicare Part A and Part B?

To enroll in Medicare Parts A and B, follow these steps:

  1. Determine your eligibility: Generally, individuals are eligible for Medicare when they turn 65. However, some individuals may be eligible earlier due to a disability or certain medical conditions. You can check your eligibility by visiting the official Medicare website or contacting the Social Security Administration.
  2. Initial Enrollment Period (IEP): If you’re not automatically enrolled in Medicare, you have an Initial Enrollment Period (IEP) to sign up. Your IEP begins three months before your 65th birthday and ends three months after the month of your 65th birthday. It’s recommended to enroll during the first three months of your IEP to ensure coverage starts on time, unless you are not retiring yet and have other creditable coverage like a group health plan.
  3. Decide if you want both Parts A and B: Medicare Part A is hospital insurance, and Medicare Part B is medical insurance. Most people choose to enroll in both parts, but you have the option to enroll in Part A only if you meet certain criteria, such as having other health coverage.
  4. Choose your enrollment method: There are different ways to enroll in Medicare:
    • Online: Visit the Social Security Administration’s website (ssa.gov) to complete your enrollment online.
    • Phone: Call the Social Security Administration at 1-800-772-1213 to enroll over the phone.
    • In-person: Visit your local Social Security office to enroll in person. It’s recommended to schedule an appointment in advance.
  5. Gather necessary documents: When enrolling, you may need certain documents, such as your Social Security number, proof of U.S. citizenship or lawful presence, and information about your current health insurance coverage
  6. Review your Medicare coverage options: While enrolling in Parts A and B provides basic coverage, you may also want to consider additional coverage options, such as a Medicare Supplement (Medigap) plan paired with a Part D prescription plan or a Medicare Advantage all-in-one type plan, to help cover out-of-pocket costs.

Contact a Medicare agent to enroll in Medicare Supplement, Medicare Advantage, or Medicare Part D.

The process and deadlines for enrollment may vary depending on individual circumstances. Visit the official Medicare website or contact Medicare directly for personalized guidance and to ensure you have all the necessary information for a successful enrollment process.

This blog is up to date as of February 2025 and has not been updated for changes in the law, administration or current events.
This information is general in nature and should not be considered financial, legal or tax advice. Consult an attorney or a tax professional regarding your specific situation.