Original Medicare
Your First Step In Understand Medicare Coverage
Original Medicare is the core of the Medicare program, and it's where most people begin. It consists of Part A (Hospital Insurance) and Part B (Medical Insurance), both managed by the federal government. These two parts form the foundation of your coverage and help pay for many essential healthcare services.
However, while Original Medicare offers broad access and is accepted by providers nationwide, it also comes with significant gaps. Understanding how it works, and where it stops, is critical to building a complete, reliable healthcare strategy in retirement.
PART A
Hospital Insurance
Part A covers inpatient care and services related to hospital stays. It’s usually premium-free for most people, but cost-sharing still applies, especially for extended stays or skilled nursing care.
What it Typically Covers:
Inpatient hospital stays
Skilled nursing facility care (after a qualifying hospital stay)
Hospice Care
Limited home health services
PART B
Medical Insurance
Part B covers outpatient services, preventive care, and medically necessary treatment like doctor visits, lab work, and imaging. There is a monthly premium, and you’re typically responsible for 20% of the costs after meeting your deductible.
What it Typically Covers:
Doctor visits (Primary and specialists)
Outpatient surgeries and procedures
Preventive screenings and vaccines
Diagnostic tests (e.g., labs, X-rays, MRIs)
Durable medical equipment (e.g., walkers, oxygen)
What It Doesn't Cover
While Original Medicare offers wide provider access and foundational coverage, it leaves major gaps that can result in substantial out-of-pocket expenses. Without additional coverage, you could be exposed to significant medical and financial risk.
What's Not Included:
Prescription Drugs - Original Medicare does not cover medications you fill at a pharmacy. You’ll need a separate Part D plan to avoid paying full retail price, or facing a late enrollment penalty.
Dental, Vision, and Hearing - Routine dental exams, cleanings, eyeglasses, hearing aids, and related services are excluded, even though these needs become more frequent with age.
Long-Term or Custodial Care - Medicare does not cover long-term stays in assisted living, nursing homes, or home-based custodial care if it's not medically necessary. This is often the most costly out-of-pocket gap in retirement planning.
Foreign Travel Emergencies - Medicare provides little to no coverage outside the U.S. If you plan to travel internationally, you’ll need supplemental protection.
Annual Out-of-Pocket Maximum - Unlike Medicare Advantage plans, Original Medicare has no limit on what you could spend in a year. That means your financial exposure continues to grow with your healthcare usage.
Curious About Other Options?
Original Medicare is a solid foundation, but for some people, it’s not enough. If you're looking for something that may include extra benefits, lower premiums, or a different way to manage your coverage, Medicare Advantage could be worth exploring.
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© 2025 Platinum Shield Insurance. All rights reserved. As a national Medicare brokerage, we work with multiple carriers to provide comprehensive plan options. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.