What Is Original Medicare?

Original Medicare is the traditional federal health insurance program administered directly by the U.S. government. It consists of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and provides health coverage for eligible people age 65 and older, as well as certain younger people with qualifying disabilities or specific medical conditions.

What is Original Medicare?

Original Medicare is the health insurance program created by the federal government in 1965.

Unlike Medicare Advantage, which is provided through private insurance companies approved by Medicare, Original Medicare is administered directly by the Centers for Medicare & Medicaid Services (CMS).

Original Medicare includes:

• Part A, which helps cover inpatient hospital care and certain other facility-based services.
• Part B, which helps cover outpatient medical care, physician services, preventive care, durable medical equipment, and many other healthcare services.

Many beneficiaries also choose to enroll in separate Medicare Part D prescription drug coverage and may purchase a Medigap policy to help pay some out-of-pocket costs.

What does Original Medicare cover?

Original Medicare provides broad coverage for medically necessary healthcare services.

Medicare Part A

Part A generally helps cover:

• Inpatient hospital stays
• Skilled nursing facility care following a qualifying hospital stay
• Hospice care
• Certain home health services

Medicare Part B

Part B generally helps cover:

• Doctor visits
• Outpatient care
• Preventive services
• Laboratory testing
• Diagnostic imaging
• Durable medical equipment
• Mental health services
• Ambulance services
• Certain home health services

Coverage is subject to Medicare rules, eligibility requirements, and medical necessity.

What isn't covered by Original Medicare?

Although Original Medicare provides comprehensive health coverage, it does not pay for every healthcare expense.

Generally, Original Medicare does not include routine coverage for:

• Most outpatient prescription drugs
• Routine dental care
• Routine vision exams and eyeglasses
• Hearing aids
• Long-term custodial nursing home care
• Most overseas medical care

Many beneficiaries obtain additional coverage through Medicare Part D, Medigap, employer-sponsored retiree coverage, or other insurance.

Who is eligible for Original Medicare?

You may qualify for Medicare if you:

• Are age 65 or older.
• Are under age 65 and have received Social Security Disability Insurance (SSDI) benefits for the required waiting period.
• Have End-Stage Renal Disease (ESRD) and meet Medicare eligibility requirements.
• Have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.

Eligibility is determined under federal law.

Original Medicare vs. Medicare Advantage

These are two different ways to receive Medicare benefits.

Original Medicare

• Administered directly by the federal government.
• Generally allows beneficiaries to see any provider nationwide who accepts Medicare.
• Does not include an annual out-of-pocket maximum for Part A and Part B services.
• Prescription drug coverage requires separate enrollment in a Medicare Part D plan.

Medicare Advantage

• Administered by Medicare-approved private insurance companies.
• Often includes provider networks.
• Frequently includes prescription drug coverage and additional benefits.
• Includes an annual maximum out-of-pocket limit for covered Part A and Part B services.

Both options provide Medicare-covered services, but they operate differently.

Original Medicare vs. Medigap

Original Medicare and Medigap work together.

Original Medicare

Pays its share of approved healthcare costs.

Medigap

Helps pay certain deductibles, copayments, and coinsurance that remain after Original Medicare pays its portion.

Medigap policies are designed specifically to supplement Original Medicare—not Medicare Advantage.

What costs should you expect?

Depending on your circumstances, costs may include:

• Medicare Part B monthly premium.
• Part A deductible (when applicable).
• Part B deductible.
• Copayments.
• Coinsurance.

Unlike Medicare Advantage, Original Medicare generally does not have an annual limit on out-of-pocket spending for Part A and Part B services.

For this reason, many beneficiaries choose to purchase Medigap coverage.

Why this matters

Choosing between Original Medicare and Medicare Advantage is one of the most important healthcare decisions beneficiaries make.

Original Medicare offers broad provider access across the country and pairs with optional Medigap coverage for additional financial protection. Understanding how it works can help beneficiaries choose coverage that fits their healthcare needs, travel habits, and budget.