Roger L. Daniel Insurance provides the Medicare 101 Educational Series to help Medicare beneficiaries better understand how Medicare coverage works. These guides explain Medicare in clear, practical terms so individuals and families can make more confident decisions before reviewing additional coverage options.
Understanding the Federal Medicare Program
Original Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). It includes Medicare Part A and Medicare Part B, which together form the foundation of Medicare coverage for hospital and medical services.
Key Points About Original Medicare
- Original Medicare includes Part A and Part B
- Part A generally helps cover inpatient hospital care
- Part B generally helps cover doctor visits and outpatient care
- Original Medicare is administered by the federal government
- Beneficiaries may still have deductibles, coinsurance, and other out-of-pocket costs
- Beneficiaries may still have deductibles, coinsurance, and other out-of-pocket costs
What Medicare Part A Covers
Medicare Part A is often referred to as hospital insurance. It generally helps cover medically necessary inpatient care received in approved settings.
Part A may help cover:
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inpatient hospital stays
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skilled nursing facility care following a qualifying hospital stay
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some home health services
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hospice care for individuals who meet Medicare requirements
Although Part A helps cover major hospital-related expenses, it does not eliminate all costs. Beneficiaries may still be responsible for deductibles, copayments, coinsurance, or services that Medicare does not cover.
What Medicare Part B Covers
Medicare Part B is often referred to as medical insurance. It generally helps cover outpatient services and medically necessary care outside of an inpatient hospital stay.
Part B may help cover:
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doctor visits
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specialist visits
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preventive services
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outpatient treatment
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lab work
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durable medical equipment
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ambulance services in approved situations
Part B usually includes a monthly premium and may also involve deductibles and coinsurance. Understanding how Part B works helps beneficiaries better prepare for the costs that can remain under Original Medicare.
How Medicare Part A and Part B Work Together
Medicare Part A and Part B are designed to work together as the core structure of Original Medicare. Part A generally helps with inpatient hospital-related services, while Part B generally helps with outpatient and physician services.
This combined structure gives beneficiaries broad access to care through providers who accept Medicare. However, Original Medicare does not place a cap on all out-of-pocket medical spending, which is one reason many people review additional coverage after first understanding the foundation.
What Original Medicare Does Not Cover
Original Medicare provides important coverage, but it does not pay every healthcare expense. Beneficiaries may still be responsible for certain costs, and some services may not be covered at all.
Common gaps in Original Medicare may include:
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deductibles
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coinsurance
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copayments
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most routine dental care
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most routine vision care
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most hearing aids
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most outpatient prescription drugs
Because of these gaps, many beneficiaries choose to review additional coverage options after they understand how Original Medicare works.
Why Understanding Original Medicare Matters First
Before comparing other Medicare choices, it helps to understand the federal Medicare program itself. Original Medicare is the starting point for Medicare decision-making because it explains what coverage is already in place and where additional costs may remain.
When beneficiaries understand Original Medicare first, they are usually better prepared to review Medicare Supplement coverage, Medicare Advantage plans, or Part D prescription drug coverage in a more informed way.
Request Information About Your Medicare Coverage
If you would like help understanding Original Medicare and reviewing how Part A and Part B fit into your overall coverage picture, our office is happy to answer questions and help you review your options.
This website and the Medicare 101 educational series are not affiliated with or endorsed by the U.S. government or the federal Medicare program.
There is no cost for a Medicare coverage review.
For official information about Medicare coverage, benefits, and eligibility, visit Medicare.gov.
Frequently Asked Questions
What is Original Medicare?
Original Medicare is the federal Medicare program made up of Medicare Part A and Medicare Part B. These two parts form the foundation of Medicare coverage.
Does Original Medicare include prescription drug coverage?
Original Medicare does not include most outpatient prescription drug coverage. Many beneficiaries review separate prescription drug coverage for that reason.
Can I see any doctor with Original Medicare?
In most cases, beneficiaries with Original Medicare may see any provider in the United States who accepts Medicare patients.
Does Original Medicare cover all healthcare costs?
No. Original Medicare helps cover many medical services, but beneficiaries may still have deductibles, coinsurance, copayments, and other expenses.
This information is based on publicly available guidance from the Centers for Medicare & Medicaid Services.