Original Medicare provides valuable healthcare coverage, but it does not pay 100% of your healthcare expenses. With Medicare Part A and Part B, you may be responsible for deductibles, coinsurance, and other costs.

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One of the most important things to understand is that Original Medicare does not have an annual out-of-pocket maximum for Part A and Part B services. This means your expenses can become significant if you experience a serious illness, hospitalization, or need ongoing medical treatment.

Medicare Part A – Hospital Insurance

Medicare Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home health services.

For 2026, the Part A inpatient hospital deductible is $1,736 per benefit period.

For a Medicare-covered inpatient hospital stay in 2026:

• Days 1–60: $0 coinsurance after the Part A deductible.

• Days 61–90: $434 per day.

• Days 91–150: $868 per day while using your lifetime reserve days. You have up to 60 lifetime reserve days over your lifetime.

• After Day 150: You are responsible for all costs once your lifetime reserve days have been exhausted.

Skilled Nursing Facility Care

For a Medicare-covered skilled nursing facility stay in 2026:

• Days 1–20: $0 coinsurance.

• Days 21–100: $217 per day.

• After Day 100: You are responsible for all costs.

Medicare's skilled nursing facility benefit is designed for qualifying skilled care, not indefinite custodial or long-term care.

Medicare Part B – Medical Insurance

Medicare Part B helps cover physician services, outpatient hospital services, durable medical equipment, certain home health services, and many other medically necessary services.

For 2026, the standard Part B premium is $202.90 per month, although some beneficiaries pay more based on income. The annual Part B deductible is $283.

After meeting the deductible, you generally pay 20% of the Medicare-approved amount for most Part B-covered services.

And here's the important part:

There is no annual out-of-pocket maximum under Original Medicare for Part A and Part B.

That means the 20% coinsurance can become a significant expense if you require frequent medical care, outpatient procedures, chemotherapy, durable medical equipment, or other costly covered services.

What Are Part B Excess Charges?

Doctors and other providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment for covered services.

Certain providers who don't accept assignment may be permitted to charge more than the Medicare-approved amount. In many cases, the additional amount can be up to 15% above the Medicare-approved amount, subject to Medicare rules and state law.

This additional amount is known as a Part B excess charge.

Medicare Part D – Prescription Drug Coverage

Original Medicare does not automatically include most outpatient prescription drug coverage. Beneficiaries can obtain Part D coverage through a private Medicare-approved insurance company.

Part D premiums, formularies, pharmacy networks, copayments, and coinsurance vary by plan.

For 2026, no Part D plan can have a deductible greater than $615, although some plans have a lower deductible or no deductible.

After the applicable deductible, you pay your plan's required cost sharing for covered medications. Under the standard Part D benefit, beneficiary coinsurance is generally 25% during the initial coverage stage.

Once qualifying out-of-pocket spending on covered Part D medications reaches $2,100 in 2026, you enter catastrophic coverage and generally pay $0 for covered Part D drugs for the remainder of the calendar year.

Why Additional Coverage May Be Important

Original Medicare provides significant healthcare coverage, but the deductibles and coinsurance can leave you financially exposed—particularly because Part A and Part B don't have an annual out-of-pocket maximum.

Many Medicare beneficiaries choose additional coverage to help manage these expenses.

A Medicare Supplement (Medigap) policy works alongside Original Medicare and can help pay certain deductibles, copayments, and coinsurance, depending on the plan selected.

Another option is a Medicare Advantage (Part C) plan offered by a private Medicare-approved insurance company. Medicare Advantage plans replace Original Medicare as the way you receive your Part A and Part B benefits and have an annual limit on your out-of-pocket costs for covered medical services. Costs, networks, benefits, and limits vary by plan.

Understanding Your Options Matters

Medicare isn't one-size-fits-all. Your medications, doctors, healthcare needs, budget, travel habits, and financial situation can all influence which coverage option may work best for you.

Understanding what Medicare pays—and what you're responsible for—is an important part of choosing your coverage.

We can help you compare your Medicare options, understand potential out-of-pocket expenses, and make an informed decision based on your individual needs.

Medicare costs and benefits can change annually. Plan premiums, benefits, provider networks, formularies, and availability vary by plan and service area.