What Is Original Medicare?
Original Medicare is the traditional way to receive Medicare coverage directly through the federal Medicare program. It includes Medicare Part A, which is hospital insurance, and Medicare Part B, which is medical insurance.
With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare. You may also add a separate Medicare Part D prescription drug plan and, if eligible, purchase Medicare Supplement Insurance—also called Medigap—to help with certain out-of-pocket costs.
Key Takeaways
Original Medicare includes Part A and Part B.
Part A primarily covers inpatient and hospital-related care.
Part B primarily covers doctor services, outpatient care, preventive services, and medical equipment.
You can generally use any healthcare provider in the United States that accepts Medicare.
Original Medicare does not usually include outpatient prescription drug coverage.
You may add a separate Part D prescription drug plan.
Medigap may help pay some of the costs left by Original Medicare.
Original Medicare does not have a built-in annual maximum on your Part A and Part B out-of-pocket costs.
What Does Original Medicare Include?
Original Medicare is made up of two parts:
Medicare Part A — Hospital Insurance
Medicare Part A helps cover qualifying hospital and facility-based services, including:
Inpatient hospital care
Skilled nursing facility care when Medicare requirements are met
Hospice care
Certain home health services
Part A does not cover every type of care received inside a hospital. Whether a person has been formally admitted as an inpatient or is receiving outpatient or observation services can affect which part of Medicare applies.
Learn more: Medicare Part A
Medicare Part B — Medical Insurance
Medicare Part B helps cover medically necessary and preventive services, including:
Services from doctors and other healthcare providers
Outpatient care
Many preventive services, screenings, shots, and vaccines
Durable medical equipment, such as certain wheelchairs, walkers, and hospital beds
Certain home health services
Some medications administered in a doctor’s office or outpatient setting
A simple way to remember the difference is:
Part A is primarily hospital insurance. Part B is primarily medical and outpatient insurance.
Learn more: Medicare Part B
How Does Original Medicare Work?
With Original Medicare, you receive covered Part A and Part B services through Medicare rather than through a private Medicare Advantage plan.
When you receive a covered service:
Medicare determines the Medicare-approved amount for the service.
Medicare pays its share.
You are responsible for any applicable premium, deductible, copayment, or coinsurance.
You pay for services as you receive them rather than paying one fixed amount that covers all of your healthcare for the year.
Can You Use Any Doctor With Original Medicare?
You can generally use any doctor, hospital, or other healthcare provider in the United States that accepts Medicare.
Original Medicare normally does not require you to choose a primary care doctor. In most cases, you also do not need a referral to see a specialist. Prior authorization is generally less common under Original Medicare than it may be under a Medicare Advantage plan.
However, it is still important to ask whether a provider:
Accepts Medicare patients
Accepts Medicare assignment
Has opted out of Medicare
What Does “Accepts Assignment” Mean?
A provider who accepts assignment agrees to accept the Medicare-approved amount as full payment for a covered service.
When a provider accepts assignment:
Your out-of-pocket costs may be lower.
The provider agrees to charge only the applicable Medicare deductible and coinsurance.
The provider must submit the claim directly to Medicare.
A provider may accept Medicare patients without accepting assignment in every situation. In that case, the provider may sometimes charge more than the Medicare-approved amount. Always confirm the provider’s Medicare status before receiving non-emergency care.
What Does Original Medicare Cost?
Original Medicare does not pay the entire cost of covered healthcare.
Depending on the service and your circumstances, you may pay:
A monthly Part B premium
A Part A premium if you do not qualify for premium-free Part A
Part A and Part B deductibles
Copayments
Coinsurance
For many Part B-covered services, after the Part B deductible is met, Medicare generally pays 80% of the Medicare-approved amount and you pay 20% when the provider accepts assignment. Different services can have different cost-sharing rules.
Does Original Medicare Have a Maximum Out-of-Pocket Limit?
No. Original Medicare by itself does not have a built-in annual maximum on what you may pay out of pocket for covered Part A and Part B services.
This means there is no single dollar amount at which Original Medicare automatically begins paying 100% of all covered Part A and Part B costs for the rest of the year.
Other coverage may help limit or pay some of those costs, including:
Medicare Supplement Insurance, or Medigap
Medicaid
Employer or union coverage
Retiree coverage
Other qualifying insurance
Does Original Medicare Include Prescription Drug Coverage?
Original Medicare does not generally include coverage for most prescriptions you pick up at a retail pharmacy.
Medicare Part B covers certain medications in limited situations, such as some drugs administered by a healthcare provider or used with covered medical equipment. For broader prescription drug coverage, a person with Original Medicare can enroll in a separate Medicare Part D prescription drug plan.
It is important to consider drug coverage when first becoming eligible for Medicare. Going 63 consecutive days or longer without Part D or other creditable prescription drug coverage may result in a late-enrollment penalty if you enroll in Part D later.
Learn more: Medicare Part D
What Does Original Medicare Not Cover?
Original Medicare covers many medically necessary hospital and medical services, but it does not cover everything.
Services and items that are generally not covered include:
Most routine dental care
Dentures
Routine eye exams for prescription glasses
Hearing aids and exams for fitting hearing aids
Routine physical examinations
Cosmetic surgery
Massage therapy
Most non-medical long-term care
Most healthcare received outside the United States
There can be exceptions. For example, Medicare may cover certain dental services when they are closely connected to a covered medical procedure. Part B may also cover diagnostic hearing or balance testing when medically necessary, even though hearing aids are not generally covered.
Before receiving a service, ask the provider whether Medicare is expected to cover it and what your estimated cost may be.
Where Does Medigap Fit?
Medicare Supplement Insurance—commonly called Medigap—is private insurance designed to work with Original Medicare.
A Medigap policy may help pay some of the out-of-pocket costs left by Part A and Part B, such as certain:
Deductibles
Copayments
Coinsurance amounts
Original Medicare pays first for a covered service, and the Medigap policy may then pay according to the policy’s benefits.
Medigap is not a separate way to receive Medicare benefits. It supplements Original Medicare.
Important points to remember:
You generally must have both Part A and Part B to purchase Medigap.
Medigap does not work with Medicare Advantage.
Medigap policies sold after 2005 do not include prescription drug coverage.
A separate Part D plan may be added for prescription drug coverage.
Learn more: What Is Medigap?
Original Medicare vs. Medicare Advantage
Original Medicare and Medicare Advantage are the two main ways to receive Medicare Part A and Part B benefits. They are not meant to be used together as two primary forms of Medicare coverage.
Original Medicare
Includes Part A and Part B
Benefits are received directly through Medicare
Allows access to any provider in the United States that accepts Medicare
Usually does not require specialist referrals
Generally uses less prior authorization
Allows you to add a separate Part D plan
Allows you to purchase Medigap if eligible
Does not have a built-in annual Part A and Part B out-of-pocket maximum
Medicare Advantage
Is also called Medicare Part C
Provides Part A and Part B benefits through a Medicare-approved private insurance plan
May use provider networks and service areas
May require referrals or prior authorization
Usually includes Part D prescription drug coverage
Has an annual maximum out-of-pocket limit for covered Part A and Part B services
Cannot be combined with Medigap
May offer additional benefits not included in Original Medicare
Neither coverage path is automatically best for everyone. The right fit depends on factors such as provider access, medications, budget, travel, supplemental coverage, and comfort with plan rules.
Learn more: Compare Your Options
Questions to Ask When Considering Original Medicare
Before deciding how to receive your Medicare coverage, consider asking:
Do my doctors and hospitals accept Medicare?
Do they accept Medicare assignment?
Do I want the flexibility to see Medicare providers throughout the United States?
How would I manage deductibles and coinsurance?
Am I eligible to purchase a Medigap policy?
Do I need a separate Part D prescription drug plan?
Are my medications covered by the Part D plan I am considering?
How much could I pay during a year with frequent medical care?
Do I have employer, retiree, Medicaid, military, or other coverage that works with Medicare?
Do I frequently travel outside the United States?
Understanding these questions can help you compare the structure of Original Medicare with other Medicare coverage options.
Frequently Asked Questions
Is Original Medicare the Same as Medicare Parts A and B?
Yes. Original Medicare consists of Medicare Part A and Medicare Part B.
Part A is hospital insurance, while Part B is medical insurance. Part D, Medigap, Medicaid, and employer coverage are not automatically included in Original Medicare.
Is Original Medicare a Medicare Advantage Plan?
No. Medicare Advantage is an alternative way to receive Part A and Part B benefits through a Medicare-approved private insurance company.
A person generally chooses either Original Medicare or Medicare Advantage as the primary way to receive Medicare health coverage.
Does Original Medicare Include Part D?
No. Part D is separate prescription drug coverage.
A person with Original Medicare can enroll in a stand-alone Medicare Part D plan offered by a private insurance company that follows Medicare rules.
Can I Have Original Medicare and Medigap?
Yes. Medigap is specifically designed to supplement Original Medicare.
You generally cannot use Medigap to pay Medicare Advantage deductibles, copayments, premiums, or coinsurance.
Can I Use Original Medicare Anywhere in the United States?
You can generally use any doctor, hospital, or healthcare provider in the United States that accepts Medicare patients.
Before receiving care, confirm that the provider accepts Medicare and ask whether the provider accepts assignment.
Does Original Medicare Cover Dental, Vision, and Hearing Care?
Original Medicare generally does not cover routine dental care, routine eye examinations for prescription glasses, hearing aids, or hearing-aid fitting examinations.
Certain medically necessary services may be covered in specific situations, so coverage should be confirmed before receiving care. Medicare
Does Original Medicare Cover Care Outside the United States?
Original Medicare generally does not cover medical care outside the United States, except in limited circumstances.
Some Medigap policies provide limited foreign-travel emergency benefits.
The Bottom Line
Original Medicare is the traditional Medicare coverage path made up of Part A and Part B.
It offers broad access to Medicare-participating providers throughout the United States and generally does not require provider networks or specialist referrals. However, it does not include most outpatient prescription drugs, does not cover every healthcare service, and does not have a built-in annual maximum on Part A and Part B out-of-pocket costs.
People who choose Original Medicare may also consider separate Part D prescription drug coverage and, when eligible, a Medigap policy to help manage certain costs.
The goal is not to choose a coverage path based on one feature. It is to understand how each option works and how it fits your healthcare needs, providers, medications, budget, and preferences.
Related Medicare Topics
Need Personalized Medicare Help?
Understanding how Original Medicare works is an important first step. Applying that information to your own doctors, prescriptions, budget, and other coverage can require a more personal conversation.
If you request assistance, Medicare Questions Answered can connect you with one licensed insurance professional who can discuss your individual Medicare situation.
Sources
Medicare.gov — How Does Medicare Work?
Medicare.gov — Parts of Medicare
Medicare.gov — What Original Medicare Covers
Medicare.gov — What Original Medicare Does Not Cover
Medicare.gov — Compare Original Medicare and Medicare Advantage
Medicare.gov — Does Your Provider Accept Medicare as Full Payment?
Medicare.gov — How Medigap Works