Medicare Part A vs. Part B: Differences, Pros and Cons

Medicare Part A covers hospital and inpatient care at no premium for most enrollees, while Part B covers outpatient care and doctor visits for $202.90 per month in 2026. Most people need both parts for complete Original Medicare coverage.

Compare Part A and Part B differences, costs and pros and cons below.

Written by Mark Fitzpatrick

Updated: April 22, 2026

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Key Takeaways

Medicare Part A and Part B together form Original Medicare, covering hospital and outpatient care.

Most enrollees pay $0 for Part A. Part B's 2026 standard premium is $202.90 per month.

Missing the Part B Initial Enrollment Period triggers a permanent 10% penalty per year of delay.

Part A and Part B leave cost-sharing gaps that a Medicare Supplement or Medicare Advantage plan can fill.

What Is the Difference Between Medicare Part A and Part B?

Medicare Part A covers inpatient hospital care, skilled nursing facilities, hospice and some home health care, while Part B covers doctor visits, outpatient procedures, preventive services and durable medical equipment. Most enrollees pay $0 for Part A, while Part B costs $202.90 per month in 2026.

Most people are automatically enrolled in Part A at 65 through Social Security, while Part B requires an active enrollment decision. Skipping Part B triggers a permanent 10% penalty for each full year of delay.

Feature	Part A	Part B
What It Covers	Inpatient hospital stays, skilled nursing facility care, hospice and limited home health care	Doctor visits, outpatient procedures, preventive screenings, durable medical equipment and mental health services
2026 Monthly Premium	$0 for most enrollees (40+ work quarters); $311 with 30 to 39 quarters and $565 with fewer than 30 quarters	$202.90 standard and $284.10 to $689.90 for IRMAA brackets
2026 Deductible	$1,736 per benefit period	$283 per year
2026 Coinsurance	$434/day for days 61–90, $868/day for lifetime reserve days and $217/day for SNF days 21–100	20% of Medicare-approved amount after deductible, no annual cap
Enrollment	Automatic at 65 for most Social Security recipients	Active enrollment required and delay allowed with qualifying employer plan
Late Enrollment Penalty	Possible if not enrolled when eligible and lacking qualifying coverage	10% premium surcharge per full 12-month period of delay (permanent)
Prescription Drug Coverage	None (covers drugs given during inpatient stays only)	None (a separate Part D plan is required for outpatient drugs)

All 2026 figures sourced from CMS (cms.gov).

The most consequential row for new enrollees is the Part B penalty. Unlike the Part A penalty, which has an end date, the Part B surcharge is permanent. An enrollee who delays two full years pays an extra 20% on the $202.90 monthly premium for the rest of their enrollment. Original Medicare coverage requires both parts for most beneficiaries.

What Does Medicare Part A Cover?

Medicare Part A covers four categories of care: inpatient hospital stays, skilled nursing facility care, hospice and limited home health services. The 2026 inpatient hospital deductible is $1,736 per benefit period, which applies to the first 60 days of a covered stay. The SNF benefit allows up to 100 days per benefit period following a qualifying 3-day hospital stay, with a $217 daily coinsurance from day 21.

Inpatient Hospital Care

Part A covers a semi-private room, meals, nursing care and most hospital services for medically necessary inpatient stays. The 2026 benefit period deductible is $1,736 per admission. Coinsurance of $434 per day applies from day 61 through day 90.

Skilled Nursing Facility Care

Part A covers up to 100 days in a Medicare-certified SNF following a qualifying 3-day inpatient hospital stay. Days 1 through 20 are covered at no cost. The 2026 daily coinsurance for days 21 through 100 is $217.

Hospice Care

Part A covers hospice services for beneficiaries with a terminal illness and a life expectancy of six months or less. Care includes pain management, counseling and respite services provided at home or in a Medicare-certified hospice facility.

Home Health Care

Part A covers part-time skilled nursing and therapy services at home when a physician certifies medical necessity. There is no deductible for home health services under Part A, though Part B may also cover certain qualifying home health visits.

Part A coverage applies only to Medicare-certified facilities and providers. Services must be deemed medically necessary by a physician to qualify for reimbursement under Part A.

What Does Medicare Part B Cover?

Medicare Part B covers two broad categories: medically necessary services and preventive care, including doctor visits, outpatient procedures, mental health services and durable medical equipment. The 2026 annual Part B deductible is $283 and the standard 20% coinsurance applies after the deductible is met, with no annual out-of-pocket cap. The 2026 standard monthly premium is $202.90 for most enrollees, with IRMAA surcharges adding $81.20 to $487 for higher-income beneficiaries.

Doctor and Specialist Visits

Part B covers outpatient visits to physicians, surgeons and specialists when services are medically necessary. After the $283 annual deductible, Medicare pays 80% of the approved amount and the beneficiary pays 20%, with no annual cap unless a Medigap policy applies.

Outpatient Hospital Services

Part B covers outpatient surgery, emergency room visits not resulting in admission, diagnostic tests and lab work. These services are billed separately from inpatient care and do not count against the Part A benefit period deductible.

Preventive Services

Part B covers an annual wellness visit, cancer screenings, cardiovascular and diabetes screenings and vaccinations at no cost from Medicare-participating providers. Preventive services carry no deductible or coinsurance under the mandate applied to Medicare.

Durable Medical Equipment

Part B covers medically necessary home-use equipment including wheelchairs, walkers, CPAP machines and blood glucose monitors. The standard 20% coinsurance applies after the $283 deductible. Equipment must come from a Medicare-certified supplier.

Mental Health Services

Part B covers outpatient mental health care including therapy, psychiatric evaluations and medication management, with the same 80/20 cost-sharing structure. Inpatient psychiatric facility stays are covered under Part A.

Part B coverage applies only to Medicare-participating providers. Out-of-network services may not be covered or may carry higher cost-sharing under Original Medicare.

Pros and Cons of Medicare Part A and Part B

Original Medicare's biggest strength is its provider reach. Part A and Part B are accepted by nearly every hospital and physician that takes Medicare, with no network boundaries. The trade-off is financial exposure and neither part carries an annual out-of-pocket cap, leaving cost risk open-ended without a supplemental policy.

Pros/Cons	Part A	Part B
Pros	$0 premium for most enrollees who worked 40 or more quarters Covers high-cost inpatient care with a single per-benefit-period deductible rather than per-day charges for the first 60 days SNF coverage for up to 100 days after a qualifying hospital stay reduces long-term care exposure Hospice coverage with no deductible for qualifying terminal diagnoses	Covers preventive screenings, annual wellness visits and vaccinations at no cost from participating providers 80% coverage of all medically necessary outpatient services after the $283 annual deductible Covers durable medical equipment for home use, including CPAP machines and wheelchairs Medigap Open Enrollment at age 65 guarantees access to supplemental coverage at standard rates with no medical underwriting
Cons	$1,736 deductible resets with each new benefit period, not once per year, so multiple hospitalizations in one year can trigger multiple deductibles Daily coinsurance of $434 for days 61 to 90 and $868 for lifetime reserve days creates steep exposure for extended stays No coverage for custodial long-term care in a nursing home, only skilled nursing care following a qualifying hospital stay No prescription drug coverage for outpatient medications	$202.90 monthly premium required for all enrollees with no income-based waiver for standard earners 20% coinsurance with no annual out-of-pocket cap means unlimited cost exposure for ongoing treatment Permanent 10% penalty per year of delay added to the monthly premium if enrollment is missed without a qualifying employer plan No prescription drug benefit for outpatient medications

How Much Does Medicare Part A and Part B Cost in 2026?

In 2026, most enrollees pay $0 for Part A and $202.90 per month for Part B. The bigger cost variable for Part A is not the premium but the $1,736 per-benefit-period deductible, which can reset multiple times in one year. Part B's primary financial risk is the 20% coinsurance with no annual cap, which applies indefinitely to outpatient services unless a Medicare Supplement plan or Medicare Advantage plan is in place.


Monthly premium	$0 (most enrollees, 40+ quarters): $311 (30 to 39 quarters) and $565 (fewer than 30 quarters)	Part A
Monthly premium	$202.90 standard and $284.10 to $689.90 with IRMAA	Part B
Annual/per-period deductible	$1,736 per benefit period	Part A
Annual deductible	$283 per year	Part B
Inpatient coinsurance	$434/day (days 61–90) and $868/day (lifetime reserve days)	Part A
SNF coinsurance	$217/day (days 21–100)	Part A
Outpatient coinsurance	20% of approved amount after deductible, no annual cap	Part B
Annual out-of-pocket maximum	None	Part A and Part B combined

All figures sourced from CMS (cms.gov) for calendar year 2026.
IRMAA thresholds apply to beneficiaries with modified adjusted gross income above $109,000 (individual) or $218,000 (married filing jointly) based on 2024 tax returns. Confirm current amounts at cms.gov.

The absence of an annual out-of-pocket maximum is the single largest financial risk in Original Medicare. A beneficiary hospitalized twice in one calendar year could owe two separate $1,736 Part A deductibles. Medicare Supplement Plan G removes this exposure by covering the Part A deductible and Part B coinsurance for a predictable monthly premium..

NO OUT-OF-POCKET MAXIMUM IN ORIGINAL MEDICARE

Original Medicare Part A and Part B carry no annual cap on what you can owe. Extended outpatient chemotherapy or a recurring skilled nursing facility stay can generate unlimited 20% coinsurance charges under Part B alone. Most financial planners recommend pairing Original Medicare with a Medicare Supplement plan or enrolling in a Medicare Advantage plan, which carries a 2026 in-network MOOP of $9,250.

Who Is Eligible for Medicare Part A and Part B?

Most Americans become eligible for Medicare Part A and Part B at age 65 if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). Eligibility also extends to certain people under 65 with qualifying disabilities or specific medical conditions, including end-stage renal disease and ALS.

U.S. citizens and permanent residents who have lived in the U.S. for five or more consecutive years qualify at age 65.
People under 65 enrolled in Social Security Disability Insurance (SSDI) for 24 months become eligible automatically (ALS recipients are exempt from the waiting period).
People of any age with end-stage renal disease (ESRD) requiring dialysis or a kidney transplant qualify.
Railroad Retirement Board beneficiaries follow parallel eligibility rules administered by the RRB rather than Social Security.

When Should You Enroll in Medicare Part A and Part B?

Medicare Part A and Part B enrollment timing depends on whether you're receiving Social Security benefits, whether you have qualifying employer coverage and whether you're turning 65 or qualifying through disability. Missing the right window can mean a coverage gap and a permanent premium penalty.

1
Confirm Your Automatic Enrollment Status First
If you're already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you're automatically enrolled in Part A and Part B. Your Medicare card arrives roughly three months before your 65th birthday. If you have qualifying employer coverage and don't want Part B, you must actively decline it before the effective date.
2
Use the Initial Enrollment Period if You're Not Auto-Enrolled
The Initial Enrollment Period spans seven months: the three months before your 65th birthday month, your birthday month and the three months after. Enrolling in the first three months means coverage starts on the first day of your birthday month. Enrolling in months four through seven delays coverage by one to three months.
3
Delay Part B Only With Qualifying Employer Coverage
Part B can be delayed without penalty only if you or your spouse have active employer-sponsored coverage through a current employer with 20 or more employees. COBRA, retiree plans, VA coverage and marketplace plans don't qualify for a penalty-free delay. Keep documentation of your employer coverage to avoid disputes when you later enroll. Part B enrollment rules require proof of creditable coverage.
4
Use the Special Enrollment Period When Employer Coverage Ends
When qualifying employer coverage ends, an 8-month Special Enrollment Period opens for Part B. This window doesn't extend if you delay further. Enrolling before the SEP closes avoids the permanent 10% annual penalty and typically starts coverage on the first day of the following month.
5
Secure a Medigap Plan Before the Open Enrollment Window Closes
The Medigap Open Enrollment Period opens the month you turn 65 and enroll in Part B and lasts six months. During this window, insurers must sell you any Medicare Supplement plan at standard rates with no medical underwriting. Once the window closes, insurers in most states can decline coverage or charge higher rates based on health status.

Do You Need Both Medicare Part A and Part B?

Most enrollees need both Part A and Part B. Part A's $0 premium for the majority of beneficiaries makes declining it rarely justified. Part B is the more common decision point because of its monthly cost and the only financially sound reason to defer it is active employer coverage from a current employer.

Enrollees who prefer an all-in-one plan with a network and potentially lower out-of-pocket exposure can enroll in Medicare Advantage, which replaces both Part A and Part B through a private insurer.

Medicare Part A and Part B: Bottom Line

Most Medicare enrollees need both Part A and Part B for complete Original Medicare coverage. Part A's $0 premium for the majority of beneficiaries makes it a straightforward decision. Part B's 2026 monthly cost of $202.90 and its 20% coinsurance with no annual out-of-pocket cap drive most enrollees to add a Medicare Supplement plan or a Medicare Advantage plan to limit financial exposure.

Medicare Part A vs. Part B: FAQ

We've answered the most frequently asked questions about Medicare Part A vs. Medicare Part B:

Is Medicare Part A or Part B more important?

Both are required for complete Original Medicare coverage. Part A covers hospital and inpatient care, while Part B covers outpatient services and doctor visits. Neither part alone provides the full benefit range most Medicare beneficiaries need.

What happens if I only enroll in Part A and not Part B?

Without Part B, you won't have coverage for doctor visits, outpatient procedures, preventive screenings or durable medical equipment. You'd be responsible for 100% of those costs until you enroll and a permanent penalty applies if you delay without a qualifying employer plan.

Does Medicare Part A or Part B cover prescriptions?

Neither Part A nor Part B covers routine outpatient prescription drugs. Part A covers drugs administered during an inpatient hospital stay only. For outpatient prescriptions, you need a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.

What is the Medicare Part B late enrollment penalty in 2026?

The Part B penalty adds 10% to your monthly premium for every full 12-month period you went without coverage and weren't eligible for a delay. At the 2026 standard premium of $202.90, two years of delay adds about $40.60 per month permanently.

Can I switch from Original Medicare to Medicare Advantage?

You can switch from Original Medicare to a Medicare Advantage plan during the Annual Enrollment Period each fall, or during a Special Enrollment Period if you qualify. You must be enrolled in both Part A and Part B to join any Medicare Advantage plan.

Do Part A and Part B cover dental, vision or hearing?

Original Medicare Part A and Part B don't cover routine dental, vision or hearing care. Part A covers dental services only when performed as part of a covered inpatient procedure. Medicare Advantage plans often include these benefits at varying levels of coverage.

About Mark Fitzpatrick

Mark Fitzpatrick, a Licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has analyzed the insurance market for almost a decade, first with LendingTree and now with MoneyGeek, conducting original research on hundreds of insurance companies and millions of insurance rates for insurance shoppers.

He writes about economics and insurance on MoneyGeek, breaking down complex topics so people can have confidence in their purchase. Like all MoneyGeek analysts, Mark collects and analyzes independent cost and consumer experience data on insurance companies to provide objective recommendations in our content that are independent of any of MoneyGeek's insurance company partnerships.

His insights — on products ranging from car, home and renters insurance to health and life insurance — have been featured in The Washington Post, The New York Times and NPR among others.

Mark holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He started his career working in financial risk management at State Street before transitioning to analysis of the personal insurance market. He's also a five-time Jeopardy champion!

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