What Is Original Medicare — and What Does It Actually Cover?

Original Medicare is the federal health insurance program that most Americans qualify for at age 65. It has two parts: Part A covers hospital care, and Part B covers medical services. Understanding how they work together — and where the gaps are — is the first step to building coverage that fits your life.

Talk to an Agent About Your Options

Medicare Part A: Your Hospital Insurance

Part A is what most people think of as "hospital coverage." It pays for inpatient stays, skilled nursing facility care following a qualifying hospital stay, hospice services, and some home health care. Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes for at least ten years while working. If you haven't met that threshold, a premium applies — and it's worth checking before you assume coverage is free.

 

Part A does come with a deductible. In 2025, the inpatient hospital deductible is $1,676 per benefit period — not per year. A benefit period begins when you're admitted and ends after you've been out of the hospital for 60 consecutive days, which means a second admission later in the year could trigger a second deductible. That structure surprises a lot of people, and it's one of the reasons many beneficiaries choose to add supplemental coverage on top of Original Medicare.

Medicare Part B: Your Medical Insurance

Part B covers the services you use most — doctor visits, outpatient care, preventive screenings, lab work, durable medical equipment, and many mental health services. Unlike Part A, Part B always requires a monthly premium. In 2025, the standard Part B premium is $185.00 per month, though higher-income beneficiaries pay more through a surcharge called IRMAA (Income-Related Monthly Adjustment Amount).

 

Part B also carries an annual deductible — $257 in 2025 — after which Medicare pays 80 percent of approved costs. You are responsible for the remaining 20 percent, with no out-of-pocket maximum under Original Medicare alone. For someone managing a serious illness or frequent specialist visits, that 20 percent can add up quickly.

What Original Medicare Does and Doesn't Cover

Original Medicare covers a wide range of medically necessary services, but it has meaningful gaps that catch people off guard.

What's Included

  • Inpatient hospital stays (Part A)
  • Skilled nursing facility care following a qualifying 3-day hospital stay (Part A)
  • Hospice and home health care under qualifying conditions (Part A)
  • Doctor visits and specialist care (Part B)
  • Outpatient surgery and diagnostic tests (Part B)
  • Preventive services, including an annual wellness visit (Part B)
  • Durable medical equipment such as wheelchairs and CPAP machines (Part B)
  • Mental health services, both inpatient and outpatient (Parts A & B)

What's Not Included

Original Medicare does not cover everything, and the gaps are significant:

 

  • Routine dental, vision, and hearing care
  • Prescription drugs (covered separately under Part D)
  • Long-term custodial care, such as an extended nursing home stay
  • Care received outside the United States, with very limited exceptions
  • Cosmetic procedures

 

Because there is no out-of-pocket maximum under Original Medicare, a major health event can leave you with substantial uncovered costs. That's why many people pair Original Medicare with a Medicare Supplement (Medigap) plan or a Medicare Part D prescription drug plan.

What Medicare Covers Costs You — Understanding the Numbers

It helps to see the cost structure clearly in one place. Here's what Original Medicare requires you to pay in 2025:

 

  • Part A premium: $0 for most people (premium applies if you have fewer than 40 work credits)
  • Part A hospital deductible: $1,676 per benefit period
  • Part A coinsurance: $0 for days 1–60; $419/day for days 61–90; higher for lifetime reserve days
  • Part B premium: $185.00/month (standard; higher for some based on income)
  • Part B annual deductible: $257
  • Part B coinsurance: 20% of Medicare-approved costs after the deductible, with no cap

 

These figures change annually. We stay current on every update so you don't have to — and we'll walk you through exactly what to expect based on your situation.

How Original Medicare Fits Into Your Bigger Coverage Picture

Medicare is not a single plan. It is a system of parts, each covering a different slice of your healthcare costs. Understanding how they fit together is the first step to choosing coverage you can count on.

Pairing Original Medicare with a Medigap Plan

A Medicare Supplement plan, also called Medigap, layers on top of Original Medicare to cover some or all of the costs Medicare leaves behind — including deductibles, coinsurance, and copayments. Medigap plans are sold by private insurance companies, but they're standardized by the federal government, which means the benefits for a given plan letter are the same regardless of which carrier you choose. What differs is the premium. We shop multiple carriers to find the most competitive rate for your coverage level and health situation.

Pairing Original Medicare with a Part D Drug Plan

Original Medicare does not include prescription drug coverage. To fill that gap, most beneficiaries enroll in a standalone Medicare Part D plan. These plans vary by formulary (the list of covered drugs), monthly premium, and pharmacy network. Choosing the wrong plan can mean paying significantly more than necessary for medications you take every month. We run a side-by-side comparison based on your actual prescriptions before recommending a plan.

Considering Medicare Advantage Instead

Medicare Advantage(Part C) is an alternative to Original Medicare — not an add-on. These plans are offered by private insurers, approved by Medicare, and typically bundle hospital, medical, and drug coverage into one plan, often with additional benefits like dental and vision. Whether Advantage or Original Medicare with supplemental coverage is the better fit depends on your health needs, preferred doctors, and financial priorities. We help you compare both paths honestly.

When Original Medicare Alone Makes Sense

For some people, Original Medicare without supplemental coverage is a deliberate choice — particularly those who are healthy, rarely use medical services, and have financial resources to absorb out-of-pocket costs. It's a valid option, and we'll explain the trade-offs clearly so you can decide with full information rather than guesswork.

Why Work with an Independent Medicare Agent?

Navigating Original Medicare on your own is possible — but the decisions you make at enrollment have long-lasting consequences. Choosing the wrong enrollment window can trigger a late enrollment penalty on your Part B premium that stays with you permanently. Missing the right time to add a Medigap plan can limit your options later due to medical underwriting.

 

We've spent more than 25 years helping Michigan residents understand Medicare and make enrollment decisions they feel confident about. As an independent broker, we're not tied to any single carrier. We work with multiple insurance companies across Michigan, which means our recommendations are based on what fits you — not what earns the highest commission. Whether you're in Detroit, Grand Rapids, Lansing, or anywhere else in the state, we're here to help you get this right.

Frequently Asked Questions About Original Medicare

  • Do I have to enroll in both Part A and Part B at the same time?

    You can enroll in Part A alone if you want hospital coverage without paying the Part B premium — but most people benefit from enrolling in both. Part B covers the outpatient and physician services you're likely to use regularly, and delaying it without a qualifying reason can result in a permanent late enrollment penalty.

  • What is the Medicare deductible, and does it reset every year?

    Part B has an annual deductible that resets each January 1. Part A works differently — its deductible resets by benefit period, not by calendar year, so a hospitalization late in the year followed by another early in the next year could trigger two separate deductibles close together.

  • Does Original Medicare cover care if I travel outside Michigan?

    Yes — Original Medicare is accepted by any provider in the United States who accepts Medicare, so traveling within the country doesn't affect your coverage. However, Original Medicare provides very limited coverage outside the U.S. If you travel internationally, a Medigap plan with foreign travel coverage or a dedicated travel insurance policy may be worth considering.

  • What happens if my doctor doesn't accept Medicare assignment?

    Doctors who accept Medicare assignment agree to Medicare's approved payment amount. If your doctor doesn't accept assignment, they can charge up to 15 percent above the Medicare-approved amount — known as the limiting charge. You'd be responsible for that difference on top of your normal 20 percent coinsurance. Checking your doctor's participation status before enrolling is a step we help with.

  • Can I switch from Original Medicare to Medicare Advantage later?

    Yes. You can switch during the Annual Enrollment Period, which runs October 15 through December 7 each year, with coverage beginning January 1. There are also Special Enrollment Periods for qualifying life events. Keep in mind that if you've had a Medigap plan and want to switch back to Original Medicare from Advantage later in life, medical underwriting may apply depending on your state and health status.

Ready to Make Sense of Original Medicare?

Original Medicare is the foundation of coverage for most Americans over 65 — but it's rarely the complete picture. The gaps are real, the costs add up, and the enrollment decisions you make early can follow you for years. We're here to walk you through it at your pace, answer every question plainly, and help you build coverage that actually works for your life in Michigan.

Book a Free Consultation