The Combination: Original Medicare (Parts A & B)

When you have both Part A and Part B, you have what is known as “Original Medicare.” This is the traditional fee-for-service program offered directly by the federal government. It is the foundation of healthcare for millions of seniors and provides a solid base of coverage.

One of the biggest advantages of Original Medicare is freedom of choice. You can go to any doctor, hospital, or other facility in the United States that accepts Medicare. There are no networks to worry about, and you generally do not need a referral to see a specialist. This flexibility can be very important, especially if you travel within the country or want to see a specific expert for a health condition.

However, this freedom comes with financial exposure. As we discussed, Original Medicare has gaps. You are responsible for the Part A deductible for each hospital benefit period. You are responsible for the annual Part B deductible. And, most significantly, you are responsible for the 20% coinsurance on most Part B services, with no yearly cap on what you might have to pay out-of-pocket.

Furthermore, Original Medicare does not cover most prescription drugs you take at home. It also does not cover routine vision, dental, or hearing care. To manage these gaps, you have two main options: you can purchase separate, private insurance policies to work alongside Original Medicare (a Part D plan for drugs and a Medigap policy for cost-sharing), or you can opt for an entirely different path: a Medicare Advantage plan.

Understanding the structure of Original Medicare is the key to making an informed decision about these other options. It sets the baseline for what all Medicare plans must cover and highlights the potential out-of-pocket risks you might want to protect yourself against.