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.
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.
Final Thoughts
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.