Medicare basics
What each part does, in plain words
Part A is the hospital. Part B is the doctor. Part C is a private plan that replaces how both of them pay. Part D is the pharmacy. Everything else is detail — but the detail is where the money is.
- No jargon
- 2026 sample figures
- Written for a first read
Coverage
What is in, and what is not
The gaps matter as much as the cover. Most of the disappointment people feel about Medicare comes from the third card here.
Part A covers
Inpatient hospital stays, skilled nursing care after a qualifying admission, hospice, and some home health visits. It is hospital insurance, not nursing-home insurance — the difference costs families a great deal of money.
Part B covers
Doctor visits, outpatient surgery, lab work, durable medical equipment, ambulance rides and most preventive screening. Roughly everything that does not involve being admitted.
Neither one covers
Routine dental, routine vision and hearing aids, long-term custodial care, and most care outside the United States. Those gaps are why Advantage extras and stand-alone dental plans exist.
Part D covers
Prescriptions you fill at a pharmacy. Drugs given to you in a doctor's office usually fall under Part B instead, which is why two people can pay wildly different amounts for the same medicine.
Part A
Hospital insurance, and what it charges
Part A costs most people nothing each month. It still has a deductible, and that deductible can arrive more than once in a year.
| Item | Amount | Notes |
|---|---|---|
| Premium, 40+ quarters worked | $0 | Most people. Medicare taxes already paid for it. |
| Premium, 30–39 quarters | $285 a month | Buy-in rate for a partial work record. |
| Premium, under 30 quarters | $518 a month | Full buy-in rate. |
| Inpatient deductible | $1,736 | Per benefit period, not per year. |
| Days 1–60 coinsurance | $0 | After the deductible. |
| Days 61–90 coinsurance | $434 a day | Per day. |
| Lifetime reserve days | $868 a day | 60 days, once in your life. |
| Skilled nursing, days 21–100 | $217 a day | Days 1–20 are $0 after a qualifying stay. |
The benefit period — the part nobody explains
It starts the day you are admitted
A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility. You pay the Part A deductible for that period.
It ends after 60 days out
The period ends once you have been out of hospital and out of skilled nursing for 60 consecutive days. Not on 31 December — Part A does not work on a calendar year.
A new admission starts a new one
Go back in 61 days later and a new benefit period begins, with the $1,736 deductible due again. There is no yearly limit on how many benefit periods you can have.
Part B
Medical insurance, and the 20% with no ceiling
This is the number that surprises people. After the deductible, Part B pays 80% of the approved amount for most services — and the remaining 20% has no annual cap at all.
| Item | Amount | Notes |
|---|---|---|
| Standard premium | $185.00 a month | Higher if IRMAA applies to you. |
| Annual deductible | $257 a year | Calendar year. |
| Coinsurance after the deductible | 20% | Of the Medicare-approved amount, with no annual cap. |
| Late-enrolment penalty | 10% per 12 months | Added to the premium, usually for as long as you have Part B. |
- A Medicare Supplement pays that 20% for you, for a monthly premium.
- A Medicare Advantage plan replaces it with copays and an annual out-of-pocket maximum.
- Doing neither leaves the 20% with you, uncapped, for as long as you live.
Details worth knowing
Questions this page raises
Medicare only pays for skilled nursing facility care if you had a qualifying inpatient hospital stay of at least three consecutive days, not counting the day you are discharged. Time spent under 'observation status' does not count, even if you slept in a hospital bed for two nights. Ask the hospital, in writing, whether you have been admitted as an inpatient or are under observation — it is the single most useful question a family member can ask.
Premium-free for most people, because 40 quarters of Medicare-covered work already paid for it. With 30 to 39 quarters you can buy in at roughly $285 a month; with fewer than 30 it is around $518 a month. Free of premium is not free of cost: the deductible and coinsurance still apply. Sample figures for the 2026 plan year.
Because it was designed in 1965 as insurance against ordinary medical bills, not catastrophic ones. After the deductible you pay 20% of the approved amount for most services, with nothing stopping the total. A Medicare Supplement or a Medicare Advantage plan is how people put a ceiling on that 20%.
It depends on the size of the employer. With 20 or more employees the group plan usually pays first and you can delay Part B without penalty. With fewer than 20, Medicare generally pays first and declining Part B can leave you with the 80% your employer plan expected Medicare to cover. Check before you decline anything.
Still not sure which part pays for what?
Bring a bill, a letter or a question. Half our appointments start with someone reading a statement out loud down the phone, and most of those end in ten minutes.
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