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Original Medicare is the core of the federal health insurance program for individuals 65 and older, as well as certain younger individuals with qualifying disabilities or conditions. It consists of Part A (hospital insurance) and Part B (medical insurance)—and together, they form the baseline coverage for millions of Americans.
While Original Medicare provides access to a wide range of necessary medical services, it was never designed to cover 100% of healthcare costs. There are deductibles, copayments, coinsurance, and no out-of-pocket maximum, which means your financial responsibility can grow quickly—especially during unexpected illness or injury.
Understanding what Original Medicare does and doesn’t cover is the first step toward building a complete, cost-effective coverage strategy. At Walek Insurance, we ensure that foundation is strong, accurate, and fully aligned with your overall health goals.
Part A is designed to help cover the cost of inpatient care. This includes hospital stays, skilled nursing facility care (after a qualifying hospital stay), hospice services, and some limited home health care. Most people do not pay a premium for Part A, but there are significant deductibles and coinsurance to be aware of. It’s a critical part of your base Medicare coverage—but not a comprehensive one.
Inpatient hospital stays (semi-private room, meals, nursing care)
Skilled nursing facility care (after a 3-day hospital stay)
Hospice care for terminal illness
Limited home health care related to recovery
Part B covers outpatient care, including doctor visits, preventive screenings, medical equipment, and lab services. It’s also what you rely on for things like physical therapy, diagnostic imaging, and vaccinations. Part B requires a monthly premium and has cost-sharing in the form of deductibles and coinsurance. It’s essential for managing ongoing and preventive care needs.
Doctor office visits and outpatient services
Preventive services (screenings, vaccines, annual wellness visit)
Lab work, imaging (X-rays, MRIs, CT scans)
Durable medical equipment (e.g., walkers, oxygen supplies)
Mental health services and outpatient therapies
While Part A and Part B provide essential coverage for hospital and medical services, they are not designed to cover all healthcare costs, and they are not the only parts. In fact, many of the services people commonly expect like prescription drugs, dental work, eye exams, hearing aids, and long-term care are not included in Original Medicare. These gaps can lead to unexpected out-of-pocket expenses, especially for those managing chronic conditions or planning for the long term.
Understanding these limitations is key to building a complete Medicare strategy and why most beneficiaries choose to supplement Original Medicare with additional coverage options.
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© 2025 Walek 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.