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Medicare Basics

Parts A, B, C, and D explained in plain English.

Original Medicare (Parts A and B)

  • Provided by the federal government; covers hospital care, doctor visits, and other outpatient care.
  • Does not include prescription drug coverage, but a stand-alone prescription drug plan (Part D) can be added.
  • Hospital stay — what you pay (2026 figures):
    • $1,736 deductible per benefit period
    • $0 for the first 60 days of each benefit period
    • $434 per day for days 61–90 of each benefit period
    • $868 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
  • Skilled nursing facility stay — what you pay (2026 figures):
    • $0 for the first 20 days of each benefit period
    • $217.00 per day for days 21–100 of each benefit period
    • All costs for each day after day 100 of the benefit period
  • Part B — what you pay (2026 figures):
    • $202.90 standard monthly premium
    • $283 per year deductible
    • 20% coinsurance of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment
  • Should you stay with Original Medicare? For most people the answer is definitely no.
    • The Part A deductible is per benefit period, which could be every 60 days
    • You are responsible for 20% of all Part B charges, which can add up awfully fast
    • A Medicare Advantage plan or a Medicare Supplement is usually a better decision
  • Apply for Medicare Part B (Social Security)

Medicare Advantage (Part C)

  • You must have Medicare Part A and Part B to enroll.
  • Offered by private insurance companies.
  • Combines hospital costs and doctor and outpatient care all in one plan.
  • Plans have low premiums, sometimes as low as $0.
  • Plans in the area generally include prescription drug coverage.
  • Plans charge co-pays and coinsurance when you use their services, which can change from year to year.
  • Each plan has a yearly maximum out-of-pocket limit for in-network care; in 2026 that limit can be as high as $9,250 (most plans set theirs lower).
  • The insurance company generally requires you to use its network of doctors and facilities and to get a referral to see specialists.
  • Getting routine care when out of the service area varies greatly from plan to plan and may not be available at all.
  • Can include additional benefits such as gym memberships, hearing, vision, and dental coverage.
  • Required to cover (at least) all services that Original Medicare covers, with the exception of hospice care.
  • Cannot be combined with a Medicare Supplement insurance plan.
  • Admission vs. observation: if the hospital lists you as under observation (not admitted), it affects what co-pays apply to your situation.
  • How to choose a Medicare Advantage plan:
    • Use the Medicare plan finder on medicare.gov to see which plans give you the best prescription prices
    • Make sure that plan covers your doctors
    • Then consider co-pays for covered services, maximum out-of-pocket, coverage if you travel, and additional benefits the plan offers
  • How Medicare Advantage plans work (medicare.gov)
  • Your Medicare Advantage health plan options (medicare.gov)

Medicare Supplement (Medigap)

  • You must have Medicare Part A and Part B to buy a Medicare Supplement.
  • Your Part A and Part B deductibles and coinsurance will be paid according to the plan you choose.
  • Plan F covers all Medicare deductibles and coinsurance on any Medicare-covered service, but it can no longer be sold to people who became eligible for Medicare on or after January 1, 2020 (those eligible before then can still buy or keep it). Plan G is the popular comprehensive choice for the newly eligible — it covers everything Plan F does except the Part B deductible.
  • Helps with managing out-of-pocket costs.
  • The freedom to choose any doctor who accepts Medicare patients (accepts assignment).
  • No claim forms to file.
  • Very limited coverage outside of the United States.
  • Some plans offer additional benefits such as gym memberships, but not all.
  • Admission vs. observation: if you are listed as under observation (not admitted), Medicare will not pay for you to go to rehab; there are additional insurance plans you can buy to cover this situation.
  • How to choose a Medicare Supplement plan:
    • Review the standard chart to see which plan meets your needs best
    • The more charges you are willing to cover, the less premium you will pay
    • Choose a company you feel you can trust and consider if they offer any extras
  • Choosing a Medicare Supplement Policy (medicare.gov)

Coverage while traveling outside the US

  • Healthcare outside the United States can range from an inconvenience to a nightmare.
  • All or almost all insurance plans, including Medicare options, only cover emergency treatment outside the US — if they cover it at all.
  • Health facilities in other countries often won’t take your insurance card and figure out the billing — most want cash or credit card upfront.
  • Language barriers can make it hard to explain your problem or understand the planned treatment.
  • GeoBlue is offered as a solution — they help you every step of the way via their app or by phone, at prices described as very reasonable.
  • GeoBlue travel insurance — get info / quote

Helpful Medicare links

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