what does medicare pay and what could you still owe

Medicare Part A
(#Hospital Insurance)

What Does Medicare Part A & Part B Cover? | Medigap Comparison

 

What Should You Notice About Medicare Part A?

The Part A chart above shows some of the potentially large expenses that Original Medicare can leave to the beneficiary, and how Plan G can help fill those gaps.

  • Hospital deductible: Original Medicare has a Part A deductible for each benefit period. Plan G pays that deductible.
  • Longer hospital stays: Medicare begins charging daily hospital coinsurance after the first 60 days. Plan G pays the applicable Medicare Part A coinsurance shown in the chart.
  • Skilled Nursing Facility care: Medicare can cover qualifying skilled nursing care, but Medicare’s payment changes as the stay becomes longer. The chart shows what Medicare and Plan G pay.
  • Hospice: Medicare provides substantial hospice coverage, while Plan G can cover applicable Medicare coinsurance or copayments.

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Part B (Medical #Insurance)

 

Medicare Part B

2026 Part B deductible—$283 before Original Medicare starts to pay    You pay this deductible once each year  CMS.gov

Medi Gap Foreign Travel

 

What Should You Notice About Medicare Part B?

The Part B chart illustrates another important difference between Original Medicare alone and Original Medicare with Plan G.

  • You pay the annual Part B deductible yourself with Plan G.
  • After the Part B deductible has been met, Original Medicare generally pays 80% of the Medicare-approved amount for many Part B services.
  • Plan G generally pays the remaining 20% Medicare Part B coinsurance.
  • Plan G also covers Part B excess charges when they apply.
  • Clinical laboratory services can be different because Medicare may pay 100% of the Medicare-approved amount for covered diagnostic laboratory tests.

This 80% / 20% split is an important reason to look beyond the Medicare premium alone. Without supplemental coverage, Original Medicare has no annual maximum limiting your total out-of-pocket expenses for covered Part A and Part B services.

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Plan G Also Has a Limited Foreign Travel Emergency Benefit

  • Original Medicare generally provides very limited coverage outside the United States. As the official Plan G chart above shows, Plan G includes a limited foreign travel emergency benefit, subject to its deductible, percentage limits and lifetime maximum.
  • This is not unlimited international health insurance. If you travel frequently or spend extended periods outside the United States, additional international medical coverage may be worth considering.

How Do You Compare This With Medicare Advantage?

A Medicare Advantage plan works differently from a Medicare Supplement. It does not simply pay the amounts shown in the “You pay” column above.

Instead, a Medicare Advantage plan becomes the way you receive your Medicare Part A and Part B benefits. To compare a Medicare Advantage plan with Original Medicare plus Plan G, look at the Medicare Advantage plan’s Summary of Benefits and compare the same services shown above.

  • Hospital stay: What is the Medicare Advantage plan’s inpatient hospital copayment?
  • Doctors and specialists: What are the office visit copays?
  • Outpatient services: What are the copays or coinsurance for surgery, testing and therapy?
  • Skilled Nursing Facility: What does the plan charge per day?
  • Durable Medical Equipment: What percentage does the member pay?
  • Ambulance: What is the copayment?
  • Maximum out-of-pocket: What is the most you could pay during the year for covered Part A and Part B services?
  • Doctors and hospitals: Are your providers in the plan’s network?
  • Prior authorization: Which services require the plan’s approval before receiving care?

There isn’t one answer that is best for everybody. The purpose of comparing these costs is to understand what you are giving up and what you are gaining before choosing between Original Medicare with a Medicare Supplement and a Medicare Advantage plan.

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what does a & b cover

More detail & Explanation

What Does Medicare Part A and Part B Cover?

Original Medicare is made up of Medicare Part A and Medicare Part B. A simple way to remember the difference is that Part A generally helps cover inpatient hospital and certain facility care, while Part B generally helps cover doctors, outpatient care, medical equipment and preventive services.

Resources:

Medicare Part A vs. Part B — At a Glance

Medicare Part A
Hospital Insurance		 Medicare Part B
Medical Insurance
Inpatient hospital care Doctors and specialists
Skilled Nursing Facility care Outpatient hospital care
Hospice care Lab tests and diagnostic services
Some home health care Durable medical equipment
Inpatient mental health care Outpatient mental health care
  Ambulance services when covered
  Preventive services

Important: These are general categories. Whether Medicare pays for a particular service can depend on where you receive the care, whether the service is medically necessary and whether Medicare’s other coverage requirements are met.

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Being in the Hospital Doesn’t Always Mean Medicare Part A

One of the most important Medicare distinctions is whether the hospital has formally admitted you as an inpatient or is treating you as an outpatient.

  • You are generally an inpatient when the hospital formally admits you with an inpatient admission order.
  • You can be an outpatient while receiving emergency room services, observation services, tests or even while spending the night in a hospital bed.
  • Your status can affect what Medicare pays and what you pay.
  • Your hospital status can also affect whether a later stay in a Skilled Nursing Facility qualifies for Medicare Part A coverage.

Ask the hospital: “Am I formally admitted as an inpatient, or am I an outpatient under observation?”

Resources:

What Do You Pay With Original Medicare in 2026?

Medicare Part A — Hospital

  • Part A premium: $0 for most people who worked and paid Medicare taxes long enough.
  • Part A inpatient hospital deductible: $1,736 per benefit period.
  • Days 1–60: $0 daily coinsurance after the deductible.
  • Days 61–90: $434 per day.
  • Lifetime reserve days: $868 per day while using lifetime reserve days.

Medicare Part B — Doctors & Outpatient Care

  • Standard Part B premium: $202.90 per month in 2026. Higher-income beneficiaries may pay more.
  • Annual Part B deductible: $283 in 2026.
  • After the deductible: For many covered services, you generally pay 20% of the Medicare-approved amount.

Important: Original Medicare does not have a yearly maximum on what you can pay out of pocket. This is one reason many beneficiaries consider Medicare Supplement / Medigap coverage or Medicare Advantage.

Resources:

What Don’t Medicare Part A and Part B Cover?

Original Medicare covers a great deal of medical care, but it does not cover everything. Some commonly misunderstood exclusions include:

Skilled nursing is not the same as long-term care. Medicare Part A may cover short-term Skilled Nursing Facility care when Medicare’s requirements are met. Medicare generally does not pay for ongoing custodial care simply because someone needs help with bathing, dressing, eating or supervision.

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What About Prescription Drugs?

Medicare Part A and Part B are not a substitute for regular outpatient prescription drug coverage. Medicare Part D is primarily designed to help cover outpatient prescription drugs.

  • Part A can cover drugs you receive as part of a covered inpatient stay.
  • Part B covers certain medications under specific circumstances, including some medications administered by a doctor and certain drugs used with Part B-covered durable medical equipment.
  • Part D generally covers outpatient prescription drugs according to the drug plan’s formulary and coverage rules.
  • Many Medicare Advantage plans include Part D prescription drug coverage.

Resources:

Does Medicare Cover My Particular Test, Treatment or Equipment?

Whether Medicare covers a particular service can depend on medical necessity, where you receive the care, who provides it and Medicare’s specific coverage requirements.

Learn more about specific Medicare benefits:

Medicare.gov — Check Whether Medicare Covers a Test, Item or Service

Resources:

Part A and Part B Are Only the Beginning of Your Medicare Decision

After enrolling in Medicare Part A and Part B, you still need to decide how you want to receive your Medicare coverage and whether you need additional coverage.

  • Original Medicare
    • Includes Medicare Part A and Part B.
    • You can generally use any doctor or hospital that accepts Medicare.
    • You may add a separate Part D prescription drug plan.
    • You may be able to purchase Medicare Supplement / Medigap coverage to help with some of the deductibles and coinsurance left by Original Medicare.
  • Medicare Advantage — Part C
    • An alternative way to receive your Medicare Part A and Part B benefits through a Medicare-approved private health plan.
    • Most plans also include Part D prescription drug coverage.
    • Plans may have provider networks, referrals, prior authorization requirements and different copayments.
    • Medicare Advantage plans have an annual maximum out-of-pocket limit for covered Part A and Part B services.

Before choosing a plan, compare your doctors, hospitals, prescriptions, expected medical needs and costs.

Resources:

Medicare Part A & Part B Resources

See What Medicare Pays — and What Plan G Pays

The charts below are from the 2026 Outline of Medicare Supplement Coverage for Plan G. They are especially useful because they show, side by side:

  • Services — the type of Medicare-covered care you receive.
  • Medicare pays — what Original Medicare pays toward that service.
  • Plan pays — what Medicare Supplement Plan G pays after Medicare.
  • You pay — the amount that may still be your responsibility.

This makes it much easier to see why Medicare Supplement coverage is called Medigap: it helps pay certain deductibles and coinsurance that Original Medicare leaves behind.

Look across each row from left to right: Medicare pays first, Plan G pays its portion, and the last column shows what remains for you.

Optional Deeper Details Below
The practical explanation is above. The section below includes supporting documents, background material, citations, examples, and technical details for readers who want more.

 

 

Part B – Outpatient helps Pay For Doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care see publication 10969, but not Long Term Care. Part B helps pay for these covered services and supplies when they are medically necessary.

The chart below is a very brief summary.  Check the actual Evidence of Coverage for the plan you want to enroll in, Medicare & You or actual Medicare documents.

Steve’s VIDEO Explanation

Fact Sheet Medicare Costs

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