The Basics
Medicare Parts A, B & D: what they cover and what they cost
The building blocks of Original Medicare, straight from our advisor guides, including every 2026 number you need.
Part A: Hospital Insurance
Part A is your hospital coverage. For most people — those who worked and paid Medicare taxes for at least 10 years — Part A is premium-free. You have already paid into it throughout your working life.
What Part A Covers
Inpatient hospital stays: semi-private room, meals, nursing care, medications during stay
Skilled Nursing Facility (SNF) care: after a qualifying 3-day hospital stay
Hospice care: for terminal illness, comfort-focused care
Some home health care: medically necessary, part-time skilled nursing
Inpatient mental health: psychiatric hospital stays
What Part A Does NOT Cover
- Long-term custodial care (assisted living, nursing home day-to-day)
- Private room upgrades
- Most dental, vision, and hearing
- Prescription drugs (that's Part D)
Part A Costs in 2026
| Cost Item | 2026 Amount |
|---|---|
| Premium (if 40+ quarters worked) | $0 |
| Inpatient deductible (per benefit period) | $1,736 |
| Days 1–60 coinsurance | $0 |
| Days 61–90 coinsurance (per day) | $434/day |
| SNF days 1–20 | $0 |
| SNF days 21–100 (per day) | $217/day |
Part B: Medical Insurance
Part B is your outpatient coverage — covering doctor visits, lab work, preventive care, and much more. Unlike Part A, Part B has a monthly premium that everyone pays. In 2026, the standard premium is $202.90 per month.
What Part B Covers
Doctor visits: primary care and specialist visits
Preventive care: annual wellness visits, flu shots, cancer screenings — often at no cost
Outpatient surgery: procedures that don't require an overnight stay
Durable Medical Equipment (DME): wheelchairs, walkers, oxygen equipment
Mental health services: outpatient therapy and counseling
Ambulance services: when medically necessary
What Part B Does NOT Cover
- Routine dental, vision, and hearing
- Prescription drugs you take at home (that's Part D)
- Care received outside the U.S.
Part B Costs in 2026
| Cost Item | 2026 Amount |
|---|---|
| Monthly premium (standard) | $202.90/month |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of approved amount |
| Out-of-pocket maximum | No limit with Original Medicare alone |
Worried about that 20% with no cap? That's exactly the gap a Medigap or Advantage plan closes.
Part D: Prescription Drug Coverage
Part D covers your prescription drugs, offered through private insurance companies approved by Medicare. Enrollment is optional — but if you don't sign up when first eligible and go without creditable drug coverage, you'll face a lifetime late enrollment penalty. Even if you don't take many medications today, it's often smart to enroll.
How Part D Works
Part D plans use a formulary — a list of covered drugs divided into tiers. Lower tiers cost less, higher tiers cost more. You pay a monthly premium, an annual deductible, and then copays or coinsurance for your medications.
Tier 1: Generic drugs — lowest cost
Tier 2: Preferred brand-name drugs
Tier 3: Non-preferred brand-name drugs
Tier 4–5: Specialty drugs — highest cost
2026 Part D Key Numbers
| Cost Item | 2026 Amount |
|---|---|
| Deductible | Up to $615 (plan-specific) |
| Out-of-pocket cap | $2,100 — once hit, drugs are free for the year |
| Late enrollment penalty | 1% per month without coverage, added permanently |
Extra Help (Low Income Subsidy)
If you have a limited income, you may qualify for the Extra Help program — also called the Low Income Subsidy (LIS). This can dramatically reduce your Part D costs, sometimes to just a few dollars per prescription. Ask us about checking your eligibility.
Ready to see how the parts fit together? See every cost in one place, start with New to Medicare or compare Medigap and Medicare Advantage.
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