What Is Medicare, Anyway?

Medicare is the U.S. federal health insurance program for people 65 and older and for some younger folks with disabilities. Think of it as your health safety net for the big medical things life throws at you — hospital visits, doctor appointments, tests, and more.

Medicare has several “parts,” but we’re focusing on the most basics: Part A and Part B, commonly called Original Medicare.

🏥 Medicare Part A — Hospital Insurance

What It Covers

Part A is the part that helps pay for:

• Inpatient hospital stays
• Skilled nursing facility care
• Hospice care
• Some home health care services

Basically, it’s the stuff that generally happens in a facility or in a serious care setting.

How Much It Costs in 2026

Good news for most people: Part A is $0 per month for about 99% of beneficiaries — that’s because you (or your spouse) paid Medicare taxes while working.

But if you don’t have enough work history:

• $311/month if you have 30–39 quarters of Medicare-taxed work
• $565/month if you have fewer than 30 quarters of Medicare-taxed work

There are also deductibles and coinsurance:

• Hospital deductible: $1,736 each hospital stay (per benefit period) before Medicare kicks in.
• Hospital coinsurance if you stay longer than 60 days.
• Skilled nursing facility coinsurance after 20 days.

A benefit period starts the day you go into the hospital and ends when you’ve been out of the hospital (or skilled nursing facility) for 60 days in a row.

Who’s Eligible for Part A?

You’re generally eligible if you:

• Are 65 or older and a U.S. citizen or legal resident for 5+ years, or
• Are under 65 with certain disabilities, or
• Have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

🩺 Medicare Part B — Medical Insurance

What It Covers

Part B is the medical side of things — the stuff that happens outside of the hospital:

• Doctor visits
• Outpatient care & hospital outpatient services
• Preventive services (like flu shots, cancer screenings)
• Durable medical equipment (like wheelchairs)
• Some home health services

Basically, the routine and preventive health care things you might see your doctor for.‍

How Much It Costs in 2026

Here’s where most people really pay attention:

• Part B monthly premium: $202.90 (standard amount)
• Annual deductible: $283 before the plan starts paying its share

After you meet the deductible, you typically pay 20% coinsurance for most services — meaning Medicare pays 80% and you pay 20%.

Heads up: If your income is above certain thresholds, you may pay more for Part B each month. This extra cost is called Income-Related Monthly Adjustment Amount (IRMAA) and affects about ~8% of beneficiaries.

For example: individuals with income over $109,000 may pay more than the standard premium.

Who’s Eligible for Part B?

You’re eligible if you’re enrolled in Part A and:

• Are 65 or older, or
• Are under 65 with a qualifying disability

You usually sign up during your initial enrollment period (around your 65th birthday), or during a general/special enrollment period if you miss that window.

Pro tip: If you don’t sign up for Part B when you are first eligible and you don’t have other coverage, you could face a late enrollment penalty that stays with you long-term.

Extra Things to Know

No Out-of-Pocket Maximum

Original Medicare (Parts A & B) doesn’t have a cap on what you might spend in a year — that’s why many people also get:

• Medicare Advantage (Part C), which often has limits on out-of-pocket costs
• Medigap (Supplement plans), which help cover coinsurance and deductibles

Medicare Doesn’t Usually Cover Prescription Drugs

Part A & B don’t generally cover most prescription drugs — that’s Part D, a separate plan you can get along with Medicare.

💬 Final Thoughts

Medicare Part A and B are the foundation of health coverage for millions of Americans. It’s totally normal to feel confused — there’s a lot to keep straight! But once you know what each part does and what it costs, it becomes way less intimidating.

If you’re gearing up for eligibility or helping a loved one understand it, remember: planning ahead can save you money and stress. And if you want help comparing Medicare Advantage, Medigap, or Part D drug plans too, I can walk you through those next!