If you’re getting ready to transition into Medicare – or helping a spouse, parent, or client do it – there’s one term you’ll hear again and again: Original Medicare.
But what exactly does that mean?
And just as important – what does it not mean?
Here’s a clear breakdown of what Original Medicare Part A and Part B actually cover, what they don’t, and what you’ll need to consider next.
What Is Original Medicare?
Original Medicare refers to the two parts of Medicare provided directly by the federal government:
- Part A: Hospital Insurance
- Part B: Medical Insurance
Together, they cover many common health services for Americans aged 65 and older (and certain younger people with disabilities). If you’ve paid into Medicare taxes for long enough, you likely qualify for Part A premium-free. Part B typically comes with a monthly premium.
It’s called “Original” because it’s the baseline – the foundation of all Medicare coverage options. Everything else, like Medicare Advantage or a Supplement, builds on or replaces it. This is why it’s important to understand what Medicare covers.
What Does Medicare Part A Cover?
Think of Part A as covering most inpatient care, including:
- Hospital stays (semi-private room, meals, nursing)
- Skilled nursing facility care (short-term rehabilitation – not long-term custodial care)
- Some home health care services
- Hospice care
However, Part A is not unlimited. For example, hospital stays have deductibles and cost-sharing, and skilled nursing is only covered after a qualifying hospital stay – and only for a limited number of days.
What Does Medicare Part B Cover?
Part B is your outpatient coverage. It includes:
- Doctor visits (primary care and specialists)
- Outpatient surgeries and procedures
- Diagnostic tests (lab work, X-rays, MRIs)
- Preventive screenings (like mammograms and colonoscopies)
- Durable medical equipment (like wheelchairs or walkers)
- Some home health services
Part B has an annual deductible and typically covers 80% of approved services after that. You’re responsible for the remaining 20% – which is why many people choose to add a Medicare Supplement or Medicare Advantage plan.
What’s Not Covered by Original Medicare?
This is where people often get surprised.
Original Medicare does not cover:
- Prescription drugs (you’ll need a standalone Part D plan)
- Routine dental, vision, or hearing services
- Long-term care or custodial care
- Overseas travel coverage
This is why most people don’t stop at Original Medicare alone. It leaves significant coverage gaps, especially when it comes to out-of-pocket costs and prescriptions.
Do You Need More Than Original Medicare?
That depends on your health, your budget, and your risk tolerance.
Here are the three most common ways people use Medicare benefits:
- Stay with Original Medicare + a standalone Part D drug plan
(We call this “Bare with Medicare” – and it’s rare.) - Add a Medicare Supplement and a Part D drug plan
(This keeps Original Medicare in place and limits your out-of-pocket exposure.) - Choose a Medicare Advantage Plan (MAPD)
(These plans replace Original Medicare with a private insurance plan approved by Medicare.)
If you’re not sure which path makes sense, you can learn more about Medicare Supplement plans here or Medicare Advantage plans here.
Questions to Ask When Comparing Your “Next Steps” Options
When you’re weighing your options — Original Medicare + Part D, adding a Supplement, or switching to a Medicare Advantage plan — here are the questions you should ask yourself:
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What’s my worst-case annual cost this year? (Premiums + deductibles + copays/coinsurance + drug costs + out-of-network surprises)
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Will my doctor/hospital still take this plan next year? (Networks change; your provider may drop out.)
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If I travel or split homes, how will the plan perform out-of-area? (Seasonal living or second home matters.)
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What’s the pharmacy network and what tier are my drugs? (Your meds matter more than generic lists.)
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Does this plan protect me if I use more care than expected? (Check out-of-pocket maximums or caps—some options offer better “worst-case” protection.)
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Am I comparing apples-to-apples between Original + Supplement vs Medicare Advantage? (Features and rules differ significantly—don’t assume they match.)
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Are there coverage gaps I’m comfortable with (or not) in this option? (Original Medicare has known gaps; Supplements or Advantage fill them differently.)
Timing & Enrollment Signals
Knowing when you’re allowed to act is almost as important as what you pick. Here are the key windows for signing up for Medicare and what happens if you miss them.
Key windows at a glance:
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Initial Enrollment Period (IEP) – A seven-month window that begins three months before you turn 65 (or become eligible), includes your birthday month, and ends three months after.
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Annual Enrollment Period (AEP) – Occurs each year from October 15 to December 7. During this time you can switch Medicare Advantage plans, enroll in or drop Advantage, or switch/join Part D plans.
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Medigap Open Enrollment Period – A one-time, six-month window that starts when you are 65 and enrolled in Medicare Part B. During this window you have guaranteed issue rights for Medigap (Supplement) coverage.
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Special Enrollment Periods (SEPs) – Triggered by qualifying life events (moving, losing employer coverage, etc.). These allow you to enroll or switch outside the usual windows.
Why Hitting the Timing Matters (and What Happens If You Don’t)
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Miss your IEP or delay enrolling in Part B/Part D without another qualifying event? You risk permanent penalties on premiums.
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Miss your Medigap six-month window? You may face medical underwriting, higher premiums, or denials for coverage.
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Miss the AEP and want to switch your plan? You may have to wait until next year and could be stuck in a plan that no longer fits.
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Miss any of these windows and you face less flexibility, higher costs, or unwanted surprises.
Bottom line: Mark these dates now, set reminders, build your review into your calendar—don’t wait for the last minute.
FAQs
What’s the best path for me? Original Medicare or Medicare Advantage?
There’s no “one size fits all.” The right choice depends on your providers, medications, health needs, travel habits, and budget. Compare options side-by-side, check the fine print, and choose what fits you.
If I travel, does it matter which path I pick?
Yes — especially if you spend part of the year somewhere else. Original Medicare generally gives national access (if providers accept Medicare). Many Medicare Advantage plans have restricted networks or weak coverage out-of-area. Travel or seasonal homes should influence your decision.
What’s the biggest mistake people make when going into Medicare?
Skipping the review and assuming things stay the same. Plans, networks, drug lists, and rules change annually. Doing nothing is often more costly than switching thoughtfully.
Ready to Take Control of Your Coverage?
Original Medicare is a solid foundation – but it’s not a full house.
It’s important to understand exactly what it covers, where the gaps are, and what options you have to fill them. That’s where working with a trusted Medicare insurance agent can help.
If you don’t already have one, Brickhouse Agency offers no-cost, no-obligation consultations to walk you through your options and help you build a plan that works for your life – not someone else’s.
Book your free Medicare consultation here.
Niki Feret is the founder of Brickhouse Agency, a boutique Medicare insurance agency licensed in 37 states. As one of the few female agency owners in the industry, Niki leads with clarity, compassion, and a commitment to education – not pressure. Learn more or book your free Medicare consultation at BrickhouseAgency.com.
