When you first start learning about Medicare, the alphabet soup of "parts" can be confusing. Medicare is divided into four main parts — A, B, C, and D — each covering different types of healthcare services. Understanding the difference between Part A and Part B is the essential first step to building the right coverage strategy.
Together, Part A and Part B make up what is known as Original Medicare — the traditional, government-administered health insurance program for people 65 and older (and certain younger individuals with disabilities or specific conditions).
Medicare Part A: Hospital Insurance
Medicare Part A is often called "hospital insurance" because it primarily covers inpatient care — services you receive when you are formally admitted to a hospital or skilled nursing facility.
What Part A Covers
- Inpatient hospital care — semi-private room, meals, general nursing, and drugs as part of your inpatient treatment
- Skilled nursing facility (SNF) care — following a qualifying 3-day hospital stay, for up to 100 days per benefit period
- Home health care — part-time skilled nursing care, physical therapy, speech-language pathology, and more, when medically necessary
- Hospice care — for terminally ill patients with a life expectancy of 6 months or less
- Inpatient mental health care
What Does Part A Cost in 2026?
Most people do not pay a monthly premium for Part A if they (or their spouse) paid Medicare taxes for at least 10 years (40 quarters) while working. This is often called "premium-free Part A."
However, Part A does have cost-sharing when you use it:
- Inpatient hospital deductible: $1,676 per benefit period in 2026
- Days 1–60: $0 coinsurance per day
- Days 61–90: $419 coinsurance per day
- Days 91+: $838 per "lifetime reserve day" (you have 60 lifetime reserve days total)
- Skilled nursing facility days 21–100: $209.50 per day
Note: A "benefit period" begins the day you are admitted as an inpatient and ends when you have been out of the hospital or SNF for 60 consecutive days. There is no limit to the number of benefit periods you can have.
Medicare Part B: Medical Insurance
Medicare Part B is called "medical insurance" because it covers outpatient care — the services you receive when you are not formally admitted to a hospital.
What Part B Covers
- Doctor visits — primary care and specialist visits
- Outpatient hospital services — including emergency department visits that don't result in admission
- Preventive services — annual wellness visits, flu shots, cancer screenings, and more (many at no cost to you)
- Durable medical equipment (DME) — wheelchairs, walkers, oxygen equipment, blood sugar monitors
- Mental health services — outpatient therapy and counseling
- Ambulance services
- Clinical laboratory services — blood tests, urinalysis
- Outpatient surgery
- Some home health care (when not covered under Part A)
What Does Part B Cost in 2026?
Unlike Part A, Part B requires a monthly premium for most beneficiaries. The standard Part B premium in 2026 is $185.00 per month. Higher-income beneficiaries pay more through the Income-Related Monthly Adjustment Amount (IRMAA).
Part B also has an annual deductible of $257 in 2026. After meeting the deductible, you typically pay 20% coinsurance for most covered services, and Medicare pays the remaining 80%. There is no out-of-pocket maximum under Original Medicare alone — which is why many people add supplemental coverage.
What Original Medicare Does NOT Cover
It's important to understand the gaps in Original Medicare (Parts A and B):
- Prescription drugs (covered separately under Part D)
- Routine dental care, dentures
- Routine vision care, eyeglasses
- Hearing aids and exams
- Long-term custodial care (nursing home care)
- Most care outside the United States
- Cosmetic surgery
- Acupuncture (with limited exceptions)
How to Fill the Gaps: Part C and Medigap
Because Original Medicare leaves significant gaps — particularly the 20% coinsurance with no cap — most beneficiaries add supplemental coverage in one of two ways:
- Medicare Advantage (Part C) — a private plan that replaces Original Medicare and often includes dental, vision, hearing, and drug coverage in one plan
- Medicare Supplement Insurance (Medigap) — a private policy that works alongside Original Medicare to cover some or all of the cost-sharing (deductibles, coinsurance, copays)
The right choice depends on your health needs, budget, preferred doctors, and how often you travel. A licensed VC Health agent can walk you through both options and help you decide.
VC Health is a licensed insurance agency. Plan availability, benefits, and costs vary by location and are subject to change. Premium and cost-sharing figures are based on 2026 CMS data and are subject to annual revision. This article is for informational purposes only and does not constitute insurance advice. Not connected with or endorsed by the U.S. Government or the federal Medicare program.
