Original Medicare is run by the federal government and has two parts. Part A covers inpatient hospital care, skilled nursing after a qualifying stay, hospice and some home health care. Most people pay no Part A premium because they or a spouse paid Medicare taxes for at least 10 years.
Part B covers doctor visits, lab work, imaging, outpatient surgery, durable medical equipment such as walkers and CPAP machines, and most preventive screenings. Part B has a monthly premium that is deducted from Social Security for most people.
The trade-off is that Original Medicare has no yearly out-of-pocket limit and does not include routine dental, vision, hearing or most prescription drugs. That is why most of our Tucson clients add a Part D plan and either a Medigap policy or choose Medicare Advantage instead.
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What is included
The coverage you can expect. Exact benefits depend on the plan and the insurance company you choose.
Hospital stays (Part A)
Semi-private room, meals, nursing and hospital services during an inpatient admission.
Skilled nursing (Part A)
Up to 100 days per benefit period after a qualifying 3-day hospital stay, with daily coinsurance after day 20.
Doctor visits (Part B)
Primary care, specialists, telehealth visits and second opinions from providers that accept Medicare.
Tests and imaging (Part B)
Blood work, X-rays, MRIs, CT scans and diagnostic tests ordered by your doctor.
Preventive care (Part B)
Annual wellness visit, flu and COVID shots, mammograms, colonoscopy screenings and diabetes screenings.
Medical equipment (Part B)
Walkers, wheelchairs, oxygen, CPAP machines and diabetic testing supplies from approved suppliers.
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How we help you choose
Check your timing
We confirm your Initial Enrollment Period, or whether employer coverage lets you delay Part B without a penalty.
Handle the paperwork
We walk you through the Social Security application online or at the Tucson field office, including the CMS-L564 form if you are leaving an employer plan.
Fill the gaps
Together we decide between a Medigap plan plus Part D, or a Medicare Advantage plan that bundles everything.
Why people choose it
Freedom to see any Medicare doctor in the country
No prior authorization for most services
Works well for travel between Arizona and other states
Can be paired with a Medigap plan for near-zero surprise bills
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Costs, and what moves them
Sample figures to help you plan. Your advisor confirms the exact amounts for your age, ZIP code and plan.
Sample costs for Original Medicare. Illustrative only, not a quote.
Cost
Sample amount
Good to know
Part A premium
$0
With 40 quarters of work history
Part A hospital deductible
$1,736
Per benefit period (2026 sample)
Part B standard premium
$202.90 / month
Higher incomes pay more (IRMAA)
Part B deductible
$283 / year
Then 20% coinsurance, with no cap
Factors that change your price
Your income two years ago, which can add an IRMAA surcharge to Part B
Whether you or your spouse have 40 quarters of Medicare-taxed work
Whether you delayed Part B without creditable employer coverage
How often you use outpatient services, since Part B coinsurance has no limit
Figures are illustrative samples and not a quote. Medicare amounts change every January.
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Original Medicare questions we hear
Not always. If you have group coverage from an employer with 20 or more employees, through your own or your spouse's current job, you can usually delay Part B without a penalty. We help you confirm this with your HR team before you decide.
For most people it is not. Part B pays 80% of approved costs with no yearly cap, and it does not cover most prescriptions. Adding a Medigap plan and Part D, or choosing Medicare Advantage, protects you from large bills.
Yes. Any doctor or hospital in the U.S. that accepts Medicare will take it, which is why many snowbirds and frequent travelers prefer it.
Most people apply through Social Security online, by phone or at a local office. If you already receive Social Security benefits, you are enrolled automatically and your card arrives about three months before your 65th birthday.
