What is Original Medicare?
Original Medicare is the traditional federal health insurance program for people 65 and older (and some younger people with disabilities). It has two main parts:
- Part A — Hospital insurance. Covers inpatient hospital stays, skilled nursing, hospice, and some home health care.
- Part B — Medical insurance. Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
⚠️ Important: Original Medicare Has Significant Gaps
Original Medicare alone does NOT cap your out-of-pocket costs. There is no annual out-of-pocket maximum. You are responsible for deductibles, coinsurance, and cost-sharing — which can add up quickly with a serious illness.
2026 Medicare Cost Reference Table
| Coverage Item | Your Cost (2026) | Notes |
|---|---|---|
| Part A Premium | $0 (most people) | Free if you or spouse worked 40+ quarters |
| Part A Hospital Deductible | $1,736 | Per benefit period (not per year) |
| Hospital Days 1–60 | $0 | After deductible is met |
| Hospital Days 61–90 | $434/day | Per day coinsurance |
| Lifetime Reserve Days (91+) | $868/day | 60 lifetime reserve days total |
| Skilled Nursing Days 1–20 | $0 | After qualifying hospital stay |
| Skilled Nursing Days 21–100 | $217/day | Per day coinsurance |
| Part B Standard Premium | $202.9/month | Higher if IRMAA applies |
| Part B Annual Deductible | $283 | Must meet before coinsurance kicks in |
| Part B Coinsurance | 20% of Medicare-approved amount | After deductible. No annual cap with Original Medicare alone. |
Source: CMS.gov. Figures are for 2026. Update annually. IRMAA may increase Part B and Part D premiums for higher-income beneficiaries.
The 20% Part B Coinsurance Issue
After you meet your Part B deductible ($283 in 2026), Medicare pays 80% of the Medicare-approved amount for most services. You pay the remaining 20% — with no annual cap.
Example: Major Surgery
Medicare-approved amount: $50,000
Medicare pays (80%): $40,000
Your share (20%): $10,000 — with no cap
This is why many people choose to add a Medigap (Medicare Supplement) plan or a Medicare Advantage plan to limit their out-of-pocket exposure. Compare Medigap vs Medicare Advantage →
What Original Medicare Does NOT Cover
What Happens If You Keep Only Original Medicare?
You can keep Original Medicare without adding a Medigap plan or Medicare Advantage plan. But here is what that means for your financial exposure:
- • No annual out-of-pocket maximum — costs can be unlimited
- • 20% coinsurance on all Part B services after your deductible
- • Hospital deductible per benefit period (not per year)
- • No prescription drug coverage (you would need a standalone Part D plan)
- • No dental, vision, or hearing coverage
💡 Good to Know
If you keep Original Medicare and do not join a Medicare Advantage plan, you may still want to add a Medigap plan to cover your cost-sharing, and you will likely need a standalone Part D plan for prescription drug coverage.