Plan guide
Original Medicare
The foundation every other choice builds on. Any doctor or hospital that accepts Medicare, with cost sharing you should plan for.
Overview
Original Medicare is the federal program most people picture when they hear the word Medicare. Part A covers inpatient hospital stays, skilled nursing after a qualifying stay, hospice and some home health care. Part B covers doctor visits, outpatient procedures, lab work, preventive screenings and durable medical equipment such as walkers and CPAP machines.
Its biggest strength is freedom. There are no networks, so you can see any doctor or hospital in the country that accepts Medicare, including IU Health, Community Health Network, Eskenazi and Franciscan facilities here in Central Indiana. You do not need referrals to see a specialist.
Its biggest gap is cost exposure. Part B generally pays 80 percent of approved charges after the deductible, and there is no annual out-of-pocket maximum. That is why most of our clients on Original Medicare pair it with a Medicare Supplement plan and a stand-alone Part D drug plan.
What's included
Inpatient hospital care
Semi-private room, meals, nursing and drugs given during a covered hospital stay under Part A.
Skilled nursing facility care
Up to 100 days per benefit period after a qualifying three-day inpatient stay, with daily coinsurance after day 20.
Doctor and outpatient services
Office visits, surgeries, imaging, lab tests and emergency room care under Part B.
Preventive care
Annual wellness visit, flu and COVID shots, cancer screenings and diabetes screenings, most at no cost when the provider accepts assignment.
Durable medical equipment
Oxygen, wheelchairs, walkers, hospital beds and blood sugar monitors from Medicare-enrolled suppliers.
Hospice and home health
Intermittent skilled care at home and hospice care for terminal illness.
Benefit periods, skilled nursing and the 3-day rule
Part A does not bill in calendar years. It bills in benefit periods, and the rule that decides whether a rehab stay is covered catches more families than any other part of Original Medicare.
A benefit period is the unit Medicare actually bills in, and almost nobody arrives at the hospital knowing that. It is not a calendar year, it has no fixed length, and it decides whether a rehab stay costs you nothing or seventeen thousand dollars.
- Hospital days 1 to 60You pay$1,736 deductible, then $0 a day (sample)
The benefit period opens
A benefit period starts the day you are admitted as an inpatient. The Part A deductible is charged once per benefit period, not once per year, so a second admission months later can mean paying it a second time.
- Skilled nursing days 1 to 20You pay$0 a day
Rehabilitation at no daily cost
Medicare pays in full for skilled nursing or rehabilitation in a Medicare-certified facility, as long as a doctor has ordered it and you need skilled care daily. Room, meals, therapy and medications are all included.
- Skilled nursing days 21 to 100You pay$217 a day (sample)
Daily coinsurance begins
Eighty days at that rate is about $17,360. Supplement Plan G and Plan N both pay this coinsurance in full. Medicare Advantage plans replace it with their own daily copay schedule, which usually starts earlier than day 21.
- After day 100, and the 60-day resetYou payAll costs
Coverage stops until the clock resets
Part A covers no further skilled nursing days in that benefit period. The period only ends once you have gone 60 days in a row with no inpatient hospital and no skilled nursing care. Then a new period, and a new deductible, can begin.
The 3-day rule, and why an overnight stay might not count
- Three midnights, admittedOriginal Medicare pays for skilled nursing only after a hospital stay of at least three consecutive days as an admitted inpatient. The day you are discharged does not count toward the three.
- Observation status is outpatientA night spent under observation is billed under Part B, not Part A, and counts for nothing toward the three days, however many nights it runs.
- You must be told in writingA hospital has to hand you the Medicare Outpatient Observation Notice, the MOON, within 36 hours of starting observation services and explain it out loud. Ask for it if it does not appear.
- Most Advantage plans waive itMany Medicare Advantage plans drop the three-day requirement, then replace it with prior authorization and their own review of whether skilled care is still needed. Read the Evidence of Coverage before assuming either way.
- Getting better is not the testCoverage does not depend on improvement. Under the Jimmo settlement, skilled care given to maintain your condition or slow a decline can be covered, and a denial that says you have plateaued can be appealed.
Costs to plan for
Sample figures- Part A premium
- $0
- Part A deductible
- $1,736
- Part B standard premium
- $202.90/mo
- Part B deductible
- $283/yr
For most people with 40 or more quarters of work history
Per benefit period (2026 sample figure)
Higher incomes pay an IRMAA surcharge (2026 sample figure)
Then 20% coinsurance, with no yearly cap (2026 sample figure)
Figures are illustrations for Central Indiana. Your actual costs depend on the plan, your ZIP code, age and income. Confirm current amounts at Medicare.gov.
How we help with Original Medicare
- 1
Confirm your timing
We map your Initial Enrollment Period, or a Special Enrollment Period if you are still covered by an employer plan.
- 2
Enroll in Parts A and B
If you already draw Social Security you are enrolled automatically. Otherwise we walk you through the SSA online application.
- 3
Decide how to fill the gaps
We compare Medigap plans and Part D plans against your doctors, prescriptions and budget.
- 4
Review each fall
We check your drug plan every Annual Enrollment Period so a formulary change never catches you off guard.
Is it a fit?
Often a good fit when
- You travel or split time between Indiana and another state
- You want any doctor who accepts Medicare, with no referrals
- You plan to add a Supplement plan for predictable costs
Watch out for
- No out-of-pocket maximum on its own
- No routine dental, vision or hearing coverage
- Prescription drugs need a separate Part D plan
Questions about Original Medicare
For most people, no. The 20 percent Part B coinsurance has no annual limit, so a long hospital stay or cancer treatment can become expensive. Most clients add a Medicare Supplement and a Part D plan, or choose Medicare Advantage instead.
Not always. If you or your spouse have creditable group coverage from an employer with 20 or more employees, you can usually delay Part B without a penalty. We confirm this with your benefits administrator before you decide.
The Income-Related Monthly Adjustment Amount is a surcharge on Part B and Part D premiums for higher earners, based on your tax return from two years earlier. If your income dropped because of retirement, you can ask Social Security to reconsider using form SSA-44.
Yes. Any provider in the United States that accepts Medicare will take it. Foreign travel coverage is not included, though some Supplement plans add limited emergency coverage abroad.
Related coverage
Medicare SupplementMedigap policies that pay some or all of the costs Original Medicare leaves behind.Read the guide 
Part D drug plansStand-alone prescription drug coverage to pair with Original Medicare and a Supplement.Read the guide 
Medicare AdvantagePart C plans from private carriers that bundle hospital, medical and usually drug coverage.Read the guide
Questions about Original Medicare?
A licensed Beacon advisor will compare plans against your doctors, prescriptions and budget. No cost, no obligation.
Licensed in Indiana. TTY 711. Mon - Fri 8:00 am - 6:00 pm