Learn how Original Medicare works. We explain what is and isn’t covered, and exactly when to enroll, so you can sign up with confidence.
Original Medicare is the starting point for your health coverage, provided directly by the federal government. It is split into two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance). With Original Medicare, you have the freedom to see almost any doctor or use any hospital in the United States that accepts Medicare.
However, Original Medicare does not cover everything. It was never meant to pay for all of your medical bills. There is no limit on how much you might have to pay out of your own pocket. You are still responsible for extra costs like copays and deductibles, and Original Medicare does not pay for your prescription drugs at the pharmacy.
At Senior Benefits NW, we start by explaining your basic Medicare coverage. Then, we help you find the right additional coverage to protect you from unexpected medical costs.
Medicare Part A (Hospital Insurance) Part A pays for your care when you are admitted into a hospital or a skilled nursing facility. The good news is that most people do not pay a monthly bill (premium) for Part A, as long as you or your spouse worked and paid taxes for at least 10 years. However, if you do go to the hospital, you still have to pay a pretty large deductible before Part A kicks in. Also, if you have to stay in the hospital for more than 60 days, you will start paying a high daily fee out of your own pocket.
Medicare Part B (Medical Insurance) Part B pays for your everyday medical care, like regular doctor visits, lab tests, ambulance rides, and medical equipment (like wheelchairs). Unlike Part A, everyone must pay a monthly bill for Part B. This amount is usually taken straight out of your Social Security check. With Part B, you have to pay a small yearly deductible. After that, the government pays 80% of your covered medical bills, and you are responsible for the remaining 20%. The biggest danger is that there is no “safety cap” on that 20%. Without extra insurance, a major health issue could leave you with endless medical bills.
To properly protect yourself, you need to understand how Original Medicare works alongside private insurance options. Your choices here decide which doctors you can see and how your medical bills are handled.
Original Medicare vs. Medicare Supplements (Medigap) Medicare Supplement plans (also called Medigap) work with your Original Medicare. They don’t replace it. When you go to the doctor, Original Medicare pays its share first, and then your Medigap plan steps in to pay the leftover bills (like that 20% gap). This lets you see any doctor nationwide while keeping your medical costs predictable.
Original Medicare vs. Medicare Advantage (Part C) Medicare Advantage is an “all-in-one” package from a private insurance company. If you choose this path, you are choosing to have the private company manage your Medicare benefits instead of the government. These plans usually include prescription drug coverage and extra perks like dental and vision care. However, you will have to use their specific local networks of doctors and hospitals to be covered.
Original Medicare does not cover prescriptions. To pay for your medications and avoid lifetime penalties, you must enroll in a separate Part D Drug plan. To ensure you never over pay at the pharmacy, we’ll review your specific medications and preferred pharmacies so you can get coverage that’s right for you.
We make the Medicare enrollment process completely stress-free by giving you a clear, easy-to-follow plan.
“Blair and the team at Senior Benefits NW turned a completely overwhelming process into a clear, manageable plan. The depth of knowledge they possess regarding how the different parts of Medicare connect is truly invaluable.”
“I entered retirement completely confused by the endless stack of insurance mailers. Blair broke everything down objectively, focused purely on my health needs, and guided me to choices I feel entirely confident in.”
Most people do not pay a monthly bill for Part A (Hospital Insurance) because they already paid Medicare taxes while working. For Part B (Medical Insurance), the standard monthly cost for 2026 is $202.90. This price can be higher if you have a high income or if you sign up late and get hit with a penalty.
A benefit period is how Medicare measures your time in the hospital. It starts the day you are officially admitted to the hospital and ends when you have been out of the hospital (or nursing facility) for 60 days in a row. You can have multiple benefit periods in one year, meaning you could have to pay the large hospital deductible more than once if you have separate hospital stays.
No. Original Medicare does not pay for routine things like dental cleanings, glasses, eye exams, or hearing aids. If you want coverage for these, you will need to buy a separate dental/vision policy or enroll in a Medicare Advantage plan that includes these extra perks.
If you don’t sign up for Part B when you are first eligible, and you don’t have active health insurance from a current job, you will be hit with a permanent late fee. The government adds a 10% penalty to your monthly Part B bill for every full 12-month period you waited to sign up. You will pay this penalty for the rest of your life.
When a doctor accepts assignment, it means they agree to accept the standard price that Medicare pays for their services. This protects you from being overcharged. If a doctor accepts Medicare but does not accept assignment, they are legally allowed to charge you an extra 15% on top of the normal bill.
If you are already receiving Social Security payments before you turn 65, you will be enrolled in Medicare Parts A and B automatically. Your red, white, and blue cards will arrive in the mail about three months before your birthday. If you are not drawing Social Security yet, you have to actively sign up yourself on the Social Security website during the 7-month window around your 65th birthday.
Yes, but only if the employer has 20 or more employees. If you have active health insurance from a current job, you can usually delay signing up for Part B without getting any late penalties. Once you transition off that employer’s insurance, you get a special 8-month window to sign up for Part B with no extra fees.
Medicare will cover some home health care, but only under strict rules. A doctor must order it, you must be physically unable to leave your home easily, and you must need professional medical care (like a nurse or physical therapist). Medicare does not pay for 24-hour care, meal delivery, or general help with daily living, like bathing and dressing.
Original Medicare leaves you responsible for 20% of your medical bills with absolutely no safety limit. Pairing your basic Medicare with the right extra insurance protects your monthly budget from massive medical bills if you ever have a sudden health crisis.
The best time to reach out is at least 3 months or earlier before your 65th birthday, or 3 months before you transition off of an employer’s health insurance plan. This gives us plenty of time to check your doctors, compare plans, and get your paperwork filed perfectly so you never have a gap in your health coverage.
