Medicare News
Medicare Part A vs Part B: What's Covered in 2026
Medicare Part A vs Part B: see exactly what each covers, 2026 costs, deductibles, coinsurance rates, and where the coverage gaps are — with comparison charts.
Quick Summary
Part A covers 'inpatient' services like hospital stays, while Part B covers 'outpatient' services like doctor visits. Most people pay $0 for Part A, but Part B requires a monthly premium ($202.90 in 2026) and 20% coinsurance.
Understanding medicare part a vs part b is the most important step for any new beneficiary. These two components make up 'Original Medicare.' While they work together, they have very different rules for costs, deductibles, and what medical services they actually pay for. Here's the 2026 breakdown.
2026 Medicare Deductibles Side-by-Side
| Part A (per period) | $1,676 |
| Part B (annual) | $276 |
Comparison: Part A vs Part B at a Glance
| Feature | Part A (Hospital Insurance) | Part B (Medical Insurance) |
|---|---|---|
| Standard Premium | $0 (for most) | $202.90 per month |
| Deductible | $1,676 per benefit period | $276 per year |
| Primary Coverage | Inpatient / Hospital | Outpatient / Medical |
| Coinsurance | $0 for first 60 days | 20% after deductible |
| Doctor Visits | Only while inpatient | Yes — office & specialist |
| Home Health | Yes (post-hospital) | Yes (ongoing necessary) |
Medicare Part A: The Inpatient Breakdown
Part A is often called 'Hospital Insurance.' It covers you when you are formally admitted as an inpatient. For 2026, the costs are:
| Hospital Stay Duration | Your 2026 Cost |
|---|---|
| Days 1 - 60 | $1,676 deductible (total) |
| Days 61 - 90 | $419 per day coinsurance |
| Days 91 - 150 | $838 per day (reserve days) |
| Skilled Nursing (Days 1-20) | $0 per day |
| Skilled Nursing (Days 21-100) | $209.50 per day |
Medicare Part B: The Outpatient Breakdown
Part B covers medically necessary services and preventive care. Once you meet your $276 annual deductible, you typically pay 20% of the Medicare-approved amount for most services. Key coverage includes:
- Doctor and specialist office visits
- Outpatient surgery and emergency room visits
- Diagnostic tests (X-rays, MRIs, blood work)
- Durable medical equipment (wheelchairs, oxygen)
- Ambulance services
- Mental health services (outpatient)
Free Preventive Services
Many Part B services are covered at 100% with no deductible. This includes your 'Welcome to Medicare' visit, Annual Wellness visits, flu shots, and many cancer screenings.
The Coverage Gaps
Despite what many think, Part A and Part B have significant gaps. They do not cover routine dental, vision, hearing, or most prescription drugs. They also have no 'out-of-pocket maximum,' meaning a long illness could lead to unlimited bills.
The 20% Coinsurance: What It Really Costs You
| Procedure | Medicare-Approved Amount | Medicare Pays (80%) | You Owe (20%) |
|---|---|---|---|
| Knee Replacement Surgery | $20,000 | $16,000 | $4,000 |
| Heart Bypass Surgery | $90,000 | $72,000 | $18,000 |
| Chemotherapy (one cycle) | $15,000 | $12,000 | $3,000 |
| ER Visit (Outpatient) | $2,000 | $1,600 | $400 |
| MRI Scan | $1,500 | $1,200 | $300 |
No Out-of-Pocket Maximum With Original Medicare Alone
Unlike Medicare Advantage, Original Medicare has no annual cap on your costs. A serious illness could result in $20,000–$100,000 or more in out-of-pocket bills in a single year. This is why supplemental coverage is critical.
Filling the Gaps: Your 3 Main Options
| Feature | Medigap (Supplement) | Medicare Advantage (Part C) |
|---|---|---|
| How it works | Pays your 20% coinsurance after Medicare pays 80% | Replaces Original Medicare with an all-in-one plan |
| Doctor choice | Any Medicare-accepting provider nationwide | Network providers only |
| Monthly cost | Part B + Medigap premium ($100–$250/mo) | Part B + plan premium (often $0) |
| Extra benefits | None — need separate dental/vision plans | Dental, vision, OTC card, fitness typically included |
| Out-of-pocket risk | Very low — Medigap pays most gaps | Capped by required annual OOP maximum |
Free Part B Preventive Services You Shouldn't Miss
- Annual Wellness Visit — personalized prevention plan, $0 copay
- Depression and anxiety screenings — free annually
- Colorectal cancer screenings (colonoscopy) — $0 in most cases
- Mammograms (annual) — $0 for women over 40
- Bone density tests (osteoporosis) — free every 2 years for high-risk
- Flu, pneumonia, COVID-19, and hepatitis vaccines — $0
- Diabetes screenings — free if at risk
- Cardiovascular disease risk reduction counseling — $0
Don't Skip Your Annual Wellness Visit
Your Annual Wellness Visit is 100% free under Part B (no deductible, no copay) and includes a fall risk assessment, advance care planning, and an updated preventive care schedule. It is different from a general physical — ask for it by name.
The 'Observation Status' Trap
One of the most misunderstood gaps in Medicare is 'observation status.' A hospital can keep you for 2–3 days without formally admitting you as an 'inpatient' — instead classifying you as an outpatient under observation. This matters enormously: without an inpatient admission of at least 3 days, Medicare will NOT cover your skilled nursing facility stay afterward. If this happens, ask your doctor to admit you as an inpatient in writing.
Observation Status Affects SNF Coverage
If you spend fewer than 3 consecutive days as a formal inpatient, you don't qualify for covered Skilled Nursing Facility (SNF) care under Part A — even if you clearly need rehabilitation. Always ask: 'Am I admitted as inpatient or as observation?'
Key Takeaways
- ✓Part A covers hospital stays; Part B covers medical services
- ✓Standard Part B premium is $202.90/month in 2026
- ✓Part A has a $1,676 deductible per 'benefit period'
- ✓Part B has a $276 annual deductible + 20% coinsurance
- ✓Preventive care under Part B is mostly $0 out-of-pocket
- ✓Consider a Supplement or Advantage plan to fill the gaps
Frequently Asked Questions
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