Original Medicare: What it Does and Doesn’t Cover

Original Medicare includes two parts: A and B. The reason it is called Original Medicare is that Parts A and B used to be the only Medicare coverage available until they added Part C (Medicare Advantage) and Part D (prescription drugs) later on.

Medicare Part A helps pay for medically necessary care that requires a stay in the hospital or at a skilled nursing facility. It also covers hospice care for the terminally ill and some skilled home health care.

Medicare Part A is free if you or your spouse have paid into Social Security for 10 or more years. However, it does come with a deductible per hospital stay for each “benefit period.” This period begins when you are admitted to the hospital and ends when you have been out of the hospital for 60 days in a row. After that, what you pay changes depending on the length of your stay.

Length of Hospital StayYou Pay
Days 1-60$1,408 deductible, then nothing
Days 61-90$352 per day
Days 91-150$704 per each “lifetime reserve day” for each benefit period
(up to 60 days over your lifetime)
After 150 DaysFull cost of your hospital stay
No limit on out-of-pocket costs

Source: Medicare.gov.

Medicare Part B helps pay for medical care, including doctor office visits, lab tests and screenings, and some skilled nursing care at home, as well as the doctor services you receive when you are in the hospital.

Medicare Part B comes with a small deductible. You must also pay a monthly premium for Part B, which increases based on your income.

Medicare PayYou Pay
80% of medical care costs (once deductible is met)$198 Deductible
$144.60 monthly premium*
100% of the cost of prescription drugs
20%, of all medical care
No limit on out-of-pocket costs

Source: Medicare.gov.

*Can vary based on income and potentially how long you’ve been enrolled in the Medicare program.

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