Medicare Made Simple
Understanding Medicare's Foundation: Parts A & B
Original Medicare is the foundation of Medicare insurance coverage for millions of Americans. Whether you're turning 65 or exploring eligibility due to a qualifying disability, knowing what Medicare Part A and Part B cover-and what they don't-is the first step in making informed decisions.
At The HgO Group, we specialize in helping you understand the basics of Medicare coverage so you can build a plan that fits your needs. This is where your Medicare journey begins.
What Exactly Is Original Medicare?
Original Medicare includes two key components: Part A (Hospital Insurance) and Part B (Medical Insurance). Together, these are the building blocks of Medicare coverage.
Part A
helps cover inpatient hospital stays, hospice care, skilled nursing facilities, and some home health services.
Part B
helps cover doctor visits, outpatient services, preventive care, and durable medical equipment.
Most people become eligible for Medicare at age 65. You may also qualify earlier if you have certain disabilities or end-stage renal disease. If you or your spouse paid Medicare taxes for at least 10 years, you'll likely receive Part A premium-free.
Your Foundation for Medicare Protection
What Does Medicare Part A Cover?
Medicare Part A is often referred to as
hospital insurance, but it goes beyond just hospital stays. Here's what it typically covers:
- Inpatient hospital care
- Skilled nursing facility care (following a qualifying hospital stay)
- Hospice care for terminal illness
- Limited home health care (after hospitalization)
Costs to Expect:
- Premium: Usually $0 for those who worked and paid into Medicare for at least 10 years
- Deductible: In 2025, the hospital deductible is $1,632 per benefit period
- Copays: Vary depending on the length of the hospital or facility stay
While Part A helps with big-ticket costs, it doesn't cover everything. That's where Part B-and potentially additional coverage-comes in.
Coverage for Everyday Health
What Does Medicare Part B Cover?
Medicare Part B is your medical insurance. It helps pay for care that keeps you healthy or treats conditions without requiring a hospital stay.
Typical services include:
- Doctor visits and specialist care
- Outpatient surgery and lab tests
- Preventive screenings (mammograms, colonoscopies, flu shots, etc.)
- Durable medical equipment (wheelchairs, oxygen, etc.)
- Mental health outpatient services
Costs to Expect:
- Premium: The standard monthly premium in 2025 is approximately
$185
- Deductible: $257 annually
- Coinsurance: After meeting your deductible, Medicare generally pays 80% and you pay 20% with no cap
If your income is above a certain threshold, you may pay a higher income premium due to IRMAA (Income-Related Monthly Adjustment Amount).
Your Foundation for Medicare Protection
What's Missing from Original Medicare?
Original Medicare covers a lot-but not everything. It does
not include:
- Prescription drugs (Part D is needed)
- Routine dental, vision, or hearing exams
- Long-term custodial care (like assisted living)
- Coverage outside the U.S.
- An out-of-pocket maximum (meaning your 20% share of costs can add up significantly)
That's why many people choose to supplement Original Medicare with a Medigap plan or switch to a Medicare Advantage plan.
Coverage for Life and Work
Do I Need Extra Insurance with Medicare?
It depends on your needs-but most people do.
Option 1
Medicare Supplement (Medigap)
Medigap plans help cover the "gaps" in Parts A and B, such as deductibles and coinsurance.
Option 2
Medicare Advantage (Part C)
These are all-in-one plans that replace Original Medicare and often include drug coverage, dental, vision, and more. They may have lower premiums but come with networks and cost-sharing rules.
We'll help you evaluate both routes and choose the one that works best for your situation.
Enrollment: Don't Miss the Window
You're first eligible to enroll in Medicare during your Initial Enrollment Period-which begins 3 months before the month you turn 65 and ends 3 months after.
If you delay Part B enrollment and don't have other credible coverage (like through an employer), you could face a late enrollment penalty that lasts as long as you have Medicare.
Still working at 65? You may be able to delay Part B without penalty-but the rules can be tricky. Let's talk through it together.
Get Personalized Medicare Guidance Today
Have questions about what Original Medicare covers-or whether it's enough on its own? We're here to help.
Contact our team for a free consultation and get the clarity you need to make a confident decision about your health coverage.