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Medicare basics

Medicare Parts A and B: what each one pays for

Publicado Por Vista Insurance Services 9 min de lectura

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Part A (Hospital Insurance) helps pay for inpatient care in a hospital, care in a skilled nursing facility, hospice care and home health care. Part B (Medical Insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment and many preventive services. Together they make up Original Medicare. Each part leaves you a share of the cost, and Original Medicare has no yearly limit on what you pay out of pocket unless you have supplemental coverage or join a Medicare Advantage plan.

Table of contents

What does Part A pay for?

Part A helps pay for inpatient care you get in hospitals, critical access hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care.

A hospital stay as an inpatient

Part A covers a hospital stay when you are admitted as an inpatient with a doctor's order saying you need inpatient care to treat your illness or injury, and the hospital accepts Medicare. Covered services include:

  • a semi-private room, meals, general nursing and certain drugs
  • other hospital services and supplies that are part of your inpatient treatment

Part A doesn't cover private-duty nursing, a private room unless it is medically necessary, a television or phone in your room when there's a separate charge, or personal care items like razors or slipper socks.

Skilled nursing facility care

Part A covers skilled nursing and therapy in a skilled nursing facility for a limited time, usually only after a qualifying inpatient hospital stay. Part A limits that coverage to 100 days in each benefit period. Medicare doesn't cover custodial care, such as help with bathing, dressing or eating, if it's the only care you need.

Hospice and home health care

Hospice is end-of-life care for people with illnesses that can't be cured. Part A covers it when all three of these are true: your hospice doctor, and your regular doctor if you have one, certify that you're terminally ill, with a life expectancy of 6 months or less; you accept comfort care instead of care to cure the illness; and you sign a statement choosing hospice care instead of other Medicare-covered treatments for it. Home health care, like part-time skilled nursing or therapy when you are homebound, is covered under both Part A and Part B.

What does Part B pay for?

Part B helps cover two kinds of services: medically necessary services, which diagnose or treat a medical condition, and preventive services, which prevent illness or find it at an early stage. Part B helps cover:

  • services from doctors and other health care providers
  • outpatient care
  • home health care
  • durable medical equipment, like wheelchairs, walkers and hospital beds
  • many preventive services, like screenings, shots and yearly wellness visits
  • ambulance services
  • mental health and substance use disorder services
  • a limited number of outpatient prescription drugs

Preventive services: you pay nothing for most of them if the provider accepts assignment. Assignment means the provider agrees to accept the payment amount Medicare approves and not to bill you for more than the Medicare deductible and coinsurance.

Drugs: Medicare drug coverage (Part D) covers many drugs that Part B doesn't. You get it by joining a Part D drug plan in addition to Original Medicare, or a Medicare Advantage plan with drug coverage.

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Which part pays when you go to the hospital?

It depends on whether the hospital admits you as an inpatient.

  • Admitted as an inpatient. Part A covers the hospital's inpatient services. If you also have Part B, it generally covers 80% of the amount Medicare approves for doctors' services you get while you're in the hospital.
  • Seen in the emergency department. Part B usually covers emergency department services.

Here's how common kinds of care sort out between the two parts:

Care Which part helps pay What to know
Inpatient hospital stay Part A You must be admitted as an inpatient with a doctor's order
Doctors' services while you are an inpatient Part B Part B generally pays 80% of the amount Medicare approves
Emergency department visit Part B You pay a copayment for the visit and for each hospital service
Skilled nursing facility care Part A Usually after a qualifying inpatient stay; up to 100 days in each benefit period
Hospice care Part A For a terminal illness, when you choose comfort care and sign a hospice election statement
Home health care Part A and Part B Part-time or intermittent skilled care when you are homebound
Doctor visits and outpatient care Part B You usually pay 20% of the amount Medicare approves, after the deductible
Most preventive services Part B You pay nothing when the provider accepts assignment
Custodial care alone, like help bathing or dressing Neither Not covered when it's the only care you need

What do Parts A and B cost in 2026?

Part A premium. Most people pay no Part A premium, because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years. In its 2026 fact sheet, CMS says about 99% of people with Medicare have no Part A premium. If you don't qualify that way, you might be able to buy Part A, and you also have to sign up for Part B to buy it.

Part A deductible. In 2026 you pay $1,736 for each inpatient benefit period before Original Medicare starts to pay (CMS 2026 fact sheet). A benefit period begins the day you're admitted as an inpatient and ends when you haven't gotten any inpatient hospital care, or skilled care in a skilled nursing facility, for 60 days in a row. There's no limit to the number of benefit periods, so you may pay the deductible more than once a year.

Part B premium and deductible. The standard Part B premium is $202.90 a month in 2026, or higher depending on your income, and you pay it each month even if you don't get any Part B services. The Part B deductible is $283 a year (CMS 2026 fact sheet). After that you usually pay 20% of the cost of each covered service, as long as your provider accepts assignment.

For the daily amounts on longer hospital and skilled nursing stays, and the higher Part B premiums by income, see what Medicare costs in 2026.

What is left for you to pay?

Original Medicare doesn't cap your share. In Medicare.gov's own words:

"There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy or join a Medicare Advantage Plan (Part C)." (Medicare.gov, Costs)

You have 2 main ways to get your Medicare coverage:

  1. Original Medicare. Parts A and B, and you can use any doctor or hospital that takes Medicare. Two additions are each optional: you can join a separate Medicare drug plan (Part D), and you can buy supplemental coverage such as a Medicare Supplement (Medigap) policy, extra insurance from a private company that helps pay your share of costs in Original Medicare. Medigap policies are standardized and, in most states, named by letters, like Plan G or Plan K. You must have Part B and keep paying its premium to keep one.
  2. Medicare Advantage (Part C). A Medicare Advantage plan is an alternative to Original Medicare: a private health plan that includes Part A, Part B and usually Part D. It must cover all medically necessary services Original Medicare covers, with a few exclusions, and for some services it may use its own coverage criteria. It has a yearly limit on out-of-pocket costs, and you may need to use doctors in its network and get approval first for certain services. You keep paying your Part B premium to stay in the plan.

If you'd like to go over how Parts A and B line up with the care you actually use, ask me: Ask Jeannie to reach out.

No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.

1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana

Frequently asked questions

What has to happen before Part A pays for a skilled nursing facility stay?

Usually a qualifying inpatient hospital stay of at least 3 days in a row, counting the day you were admitted but not the day you leave. Time under observation or in the emergency room before you are admitted doesn't count, even overnight. Among the other conditions, you generally enter the facility within 30 days of leaving the hospital, and your doctor decides you need daily skilled care. You may not need the 3-day stay if your doctor takes part in an Accountable Care Organization with a 3-day rule waiver, and Medicare Advantage plans may also waive it.

Does Part A or Part B pay for an emergency room visit?

Part B usually covers emergency department services. You pay a copayment for each visit and for each hospital service, and after the Part B deductible, 20% of the amount Medicare approves for your doctor's services. If the hospital admits you for a related condition within 3 days of the visit, you don't pay those copayments, because Medicare counts the visit as part of your inpatient stay.

Does Part B pay for prescription drugs?

Only a limited number, under certain conditions. Usually Part B covers drugs you wouldn't typically give yourself, like those you get in a doctor's office or a hospital outpatient setting, and it covers flu, pneumococcal and COVID-19 vaccines. Medicare drug coverage (Part D) covers many drugs that Part B doesn't.

Who decides whether Medicare covers a service?

Coverage rests on federal and state laws, national coverage decisions Medicare makes, and local coverage decisions by the companies that process Medicare claims in each state, which decide whether something is medically necessary. Before a test or service, ask your doctor why you need it and whether Medicare will cover it.

Sources

About the author

Vista Insurance Services is a Florida fictitious name registered to Vista Consultants LLC, a Florida insurance agency (agency license L135539) with Jeannie Pond as agent in charge. Jeannie Pond is a Licensed Insurance Agent, NPN 8940178, licensed since 2009.

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