Medicare stands as a vital federal health insurance program for seniors and certain younger individuals with disabilities. Parts A and B form the foundation of Original Medicare, providing core protection against major medical expenses. Many people first encounter these parts when approaching age 65 or facing qualifying health conditions.
Part A focuses primarily on hospital-related care, while Part B addresses broader medical services. Together, they cover a wide range of needs without the extras found in other Medicare options. Understanding their roles helps beneficiaries plan effectively and avoid surprises in costs or coverage.
In 2026, updates to premiums, deductibles, and coinsurance reflect ongoing adjustments to healthcare expenses. These changes affect out-of-pocket responsibilities for millions enrolled in Original Medicare. This article explains the essentials clearly for everyday use.
What Is Medicare Part A?
Medicare Part A serves as Hospital Insurance within Original Medicare. It mainly covers inpatient stays in hospitals, skilled nursing facilities after hospital care, hospice services, and limited home health care. Most people qualify for premium-free Part A if they or a spouse worked and paid Medicare taxes for at least 10 years.
Coverage begins with inpatient hospital care, including semi-private rooms, meals, and nursing services. It also includes blood transfusions after the first three pints. Skilled nursing facility care follows a qualifying hospital stay of at least three days, focusing on rehabilitation rather than long-term custodial care.
Hospice care becomes available for those with terminal illnesses who choose comfort over curative treatment. Home health care applies when a doctor orders it and the patient remains homebound. Part A uses benefit periods rather than calendar years for tracking coverage limits.
What Is Medicare Part B?
Medicare Part B acts as Medical Insurance, covering outpatient and preventive services. It includes doctor visits, diagnostic tests, outpatient procedures, durable medical equipment, and many preventive screenings. Enrollment requires a monthly premium for nearly everyone.
Services from doctors, therapists, and other providers fall under Part B when medically necessary. It covers lab tests, X-rays, mental health care in outpatient settings, and ambulance transportation under specific conditions. Preventive benefits like flu shots, cancer screenings, and wellness visits often come at no extra cost if providers accept assignment.
Part B also pays for certain injectable drugs administered in offices or clinics. Durable medical equipment such as wheelchairs, walkers, and oxygen supplies qualifies when prescribed. Coverage extends to some home health services that complement Part A benefits.
Key Differences Between Part A and Part B
Part A and Part B target distinct care settings to provide comprehensive protection. Part A handles inpatient and facility-based needs, while Part B supports ongoing outpatient and preventive care. Both require meeting deductibles before full benefits apply.
Part A often comes without a premium for those with sufficient work history, but Part B always involves a monthly payment. Coinsurance structures differ, with Part A using daily amounts after certain days and Part B applying a flat 20% after the annual deductible. Understanding these helps in budgeting healthcare expenses.
Original Medicare combines both parts for broad access to providers who accept Medicare. Beneficiaries can see any participating doctor or hospital nationwide without network restrictions. This flexibility contrasts with other plan types that may limit choices.
2026 Costs for Part A and Part B
Costs for Medicare Parts A and B updated in 2026 to reflect rising healthcare expenses. Part A remains premium-free for most enrollees who paid sufficient Medicare taxes. Those without enough credits pay up to $565 monthly, depending on work history.
The inpatient hospital deductible rose to $1,736 per benefit period. After meeting this, the first 60 days carry no coinsurance. Days 61 through 90 require $434 daily, and lifetime reserve days cost $868 each, limited to 60 over a lifetime.
Part B features a standard monthly premium of $202.90, with higher amounts for those with elevated incomes. The annual deductible increased to $283, after which beneficiaries pay 20% of approved amounts for most services. Late enrollment penalties add 10% per year delayed.
Comparison of Part A and Part B Coverage
Here’s a clear comparison of the two main parts in Original Medicare:
| Aspect | Part A (Hospital Insurance) | Part B (Medical Insurance) |
|---|---|---|
| Primary Focus | Inpatient and facility-based care | Outpatient, preventive, and doctor services |
| Premium (2026) | $0 for most; up to $565 if purchased | $202.90 standard (higher with income) |
| Deductible (2026) | $1,736 per benefit period (hospital) | $283 annually |
| Coinsurance | $0 days 1-60; $434 days 61-90; $868 reserve | 20% after deductible |
| Key Services | Hospital stays, skilled nursing, hospice | Doctor visits, tests, equipment, screenings |
This table shows how the parts complement each other without overlap in core responsibilities.
Who Qualifies for Parts A and B?
Eligibility for Medicare Parts A and B generally starts at age 65 for U.S. citizens or legal residents with five years of continuous presence. People under 65 qualify after receiving Social Security disability benefits for 24 months. End-stage renal disease or ALS also triggers immediate access.
Automatic enrollment occurs for those already receiving Social Security or Railroad Retirement benefits before turning 65. Others must sign up during their initial enrollment period around their birthday month. Missing this window can lead to penalties unless special circumstances apply.
Spouses or dependents may gain coverage based on the working partner’s record. Premium-free Part A depends on sufficient quarters of covered employment. Those without enough credits can buy into the program by paying premiums.
How to Enroll in Parts A and B
Enrollment happens through the Social Security Administration, often online for convenience. Initial enrollment spans seven months centered on the 65th birthday month. General enrollment runs January through March each year for coverage starting July.
People already on Social Security typically receive automatic Part A and Part B. Manual sign-up suits those delaying Part B due to employer group coverage. Special enrollment periods protect against penalties when losing other insurance.
Medicare cards arrive after enrollment, showing the unique Medicare number. This number serves as identification for providers and plan comparisons. Keeping records organized prevents issues during claims.
What Parts A and B Do Not Cover
Original Medicare leaves gaps in several common areas. Routine dental, vision, and hearing services fall outside coverage. Long-term custodial nursing home care also remains uncovered, focusing only on short-term skilled needs.
Prescription drugs require separate Part D enrollment or inclusion in other plans. Cosmetic procedures, most acupuncture, and non-medically necessary items lack benefits. Travel outside the U.S. receives very limited emergency coverage.
Medigap policies help fill these gaps for Original Medicare users. Supplemental insurance pays deductibles, coinsurance, and other out-of-pocket amounts. Shopping during open enrollment ensures the best fit.
Tips for Managing Medicare Parts A and B
Stay proactive with health to minimize unexpected costs. Schedule preventive visits covered at no extra charge under Part B. Track benefit periods carefully for Part A to understand remaining days.
Review annual notices of change from Medicare for updates. Use the Medicare.gov plan finder tool to explore options. Keep provider lists of those accepting assignment to avoid balance billing.
Practical Tips:
- Carry your Medicare card or digital version at appointments.
- Ask providers about assignment acceptance before services.
- Monitor Explanation of Benefits statements for accuracy.
- Contact 1-800-MEDICARE for questions on coverage.
Conclusion
Parts A and B of Medicare deliver essential hospital and medical protection for millions of Americans. With clear distinctions in coverage and updated 2026 costs, beneficiaries can better navigate healthcare needs. Staying informed about eligibility, enrollment, and limitations empowers confident decisions.
FAQ
What is Medicare Part A?
Medicare Part A provides Hospital Insurance for inpatient hospital stays, skilled nursing facility care after qualifying hospital time, hospice, and some home health services. Most people get it premium-free after paying Medicare taxes for 10 years or more. It uses benefit periods to track coverage limits rather than annual resets.
What is Medicare Part B?
Medicare Part B offers Medical Insurance for outpatient doctor visits, preventive screenings, diagnostic tests, durable medical equipment, and certain therapies. It requires a monthly premium, set at $202.90 standard in 2026, with possible increases based on income. After the annual deductible, it covers 80% of approved amounts for most services.
How do Part A and Part B differ in coverage?
Part A targets inpatient and facility-based care like hospital admissions and short-term rehab, while Part B handles outpatient needs such as office visits, lab work, and preventive care. Part A often has no premium, but Part B always does. Coinsurance structures vary, with Part A using daily rates and Part B applying 20% coinsurance.
What are the 2026 costs for Part A?
In 2026, Part A has a $1,736 inpatient hospital deductible per benefit period. Most pay $0 premium if qualified through work history. Coinsurance includes $434 daily for days 61-90 and $868 for lifetime reserve days. Skilled nursing facility coinsurance is $217 per day for days 21-100.
What are the 2026 costs for Part B?
The standard Part B premium in 2026 is $202.90 monthly, with higher tiers for higher incomes. The annual deductible is $283. After meeting it, beneficiaries pay 20% coinsurance on most services. Late enrollment adds a permanent 10% penalty per year delayed.
Who qualifies for premium-free Part A?
Premium-free Part A goes to those who or whose spouse paid Medicare taxes for at least 40 quarters, usually 10 years of work. It also applies to people under 65 on disability after 24 months or with ESRD or ALS. Fewer quarters may allow reduced premiums or full purchase.
How do I enroll in Parts A and B?
Enrollment typically occurs automatically if receiving Social Security benefits before 65. Otherwise, sign up online via Social Security during the initial seven-month period around turning 65. General enrollment happens January to March annually. Special periods protect against penalties when losing other coverage.
Can I have only Part A without Part B?
Yes, but most choose both for full protection. Part B requires a premium and covers essential outpatient care. Dropping Part B later may incur penalties upon re-enrollment. Some delay Part B if covered by employer insurance, qualifying for special enrollment.
What happens if I miss my initial enrollment period?
Missing the initial period for Part B leads to a late enrollment penalty of 10% added to the premium for each full year delayed, lasting as long as you have Part B. Part A penalties apply only if buying it. Special enrollment avoids penalties in qualifying situations like group health plan coverage.
Do Parts A and B cover everything I need?
No, Original Medicare excludes routine dental, vision, hearing aids, long-term care, and most prescription drugs. Supplemental options like Medigap or Medicare Advantage fill these gaps. Preventive services under Part B often cost nothing when providers accept assignment.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.