Medicare Part A vs Part B in 2026 – What’s the Difference and What Does Each Cover?
Medicare is one of the most important health insurance programs in the United States. It covers tens of millions of Americans every year. But it is also one of the most confusing — especially when you are first trying to understand the difference between Part A and Part B.
If you have turned 65, are approaching 65, or receive SSDI disability benefits, this guide is for you. We explain exactly what Part A and Part B cover, what each one costs in 2026 with the latest official figures, and how to enroll without triggering penalties that can follow you for life.
What is Medicare and Who Qualifies?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It covers:
- Americans aged 65 and older
- People under 65 who have received SSDI disability benefits for at least 24 months
- People of any age with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)
Medicare has four parts. Part A and Part B together form what is called Original Medicare — the foundation of the entire program. Most people enroll in both simultaneously.
What is Medicare Part A?
Medicare Part A is hospital insurance. It covers inpatient care — meaning healthcare you receive when you are formally admitted to a hospital or skilled nursing facility overnight.
What Part A covers in 2026:
- Inpatient hospital stays including semi-private room, meals, nursing care, and medications administered during your stay
- Skilled nursing facility care after a qualifying hospital stay of at least 3 consecutive days
- Hospice care for people with a terminal illness who choose comfort care over curative treatment
- Some home health services ordered by a physician
- Inpatient psychiatric care up to 190 days in a lifetime
What Part A does NOT cover:
- Private hospital rooms unless medically necessary
- Personal items such as television, telephone, or toiletries
- Private duty nursing
- The first 3 pints of blood per year
- Long-term custodial care or nursing home care
How Much Does Medicare Part A Cost in 2026?
Most Americans pay nothing for Part A. Around 99% of Medicare beneficiaries qualify for premium-free Part A because they or their spouse paid Medicare taxes for at least 40 quarters — 10 years — during their working years. Social Security Administration
If you have fewer work credits the premiums are: If you worked 30 to 39 quarters you pay $311 per month. If you worked fewer than 30 quarters you pay $565 per month for Part A in 2026. Social Security Administration
Even with premium-free Part A you still pay cost-sharing when you use hospital services:
The Part A inpatient hospital deductible for 2026 is $1,736 per benefit period. For days 61 through 90 of a hospitalization beneficiaries pay $434 per day coinsurance. For lifetime reserve days the cost is $868 per day. Michaelarmstronglaw
An important note on the deductible — this is not an annual deductible. A benefit period starts the day you are admitted and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row. If you go back to the hospital after that a new benefit period starts and you pay the deductible again.
For skilled nursing facility stays, the daily coinsurance for days 21 through 100 of extended care services in a benefit period is $217.00 in 2026. Days 1 through 20 are covered at $0 after a qualifying hospital stay. Michaelarmstronglaw
What is Medicare Part B?
Medicare Part B is medical insurance. It covers outpatient care — healthcare you receive without being admitted to a hospital overnight, plus preventive services and medically necessary equipment.
What Part B covers in 2026:
- Doctor visits including primary care and specialist consultations
- Outpatient hospital services and same-day surgeries
- Emergency room visits when you are not admitted as an inpatient
- Ambulance transportation when medically necessary
- Durable medical equipment including wheelchairs, walkers, hospital beds, and oxygen equipment
- Mental health services including outpatient therapy and counseling
- Preventive services including annual wellness visits, flu shots, cancer screenings, diabetes screenings, and cardiovascular screenings — many at no cost to you
- Home health services ordered by a doctor
- Clinical laboratory tests and diagnostic imaging
- Physical therapy, occupational therapy, and speech therapy
What Part B does NOT cover:
- Routine dental care, dentures, or dental implants
- Routine vision exams or eyeglasses (with limited exceptions)
- Routine hearing exams or hearing aids
- Long-term custodial care
- Prescription drugs taken at home — these fall under Part D
- Cosmetic surgery
- Acupuncture (with very limited exceptions)
How Much Does Medicare Part B Cost in 2026?
Unlike Part A, everyone pays a monthly premium for Part B. The standard monthly premium for Medicare Part B enrollees is $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. Michaelarmstronglaw
This premium is automatically deducted from your Social Security or SSDI payment if you receive one.
Higher income earners pay more. Individuals with Modified Adjusted Gross Income up to $109,000 pay the standard premium of $202.90 per month. Individuals with income above $109,000 pay an additional Income Related Monthly Adjustment Amount (IRMAA) surcharge on top of the standard premium. CMS uses your tax return from two years earlier to determine your income bracket.
Additional Part B costs in 2026:
The annual deductible for all Medicare Part B beneficiaries is $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025. Michaelarmstronglaw
After meeting the annual deductible you typically pay 20% of the Medicare-approved amount for most covered services. Original Medicare has no annual out-of-pocket maximum — meaning your costs could continue to add up throughout the year. This is one of the primary reasons many beneficiaries choose to add a Medigap supplement plan.
Part A vs Part B — Complete 2026 Comparison
| Feature | Part A — Hospital | Part B — Medical |
|---|---|---|
| What it covers | Inpatient hospital and skilled nursing | Doctor visits and outpatient care |
| 2026 Premium | $0 for most people | $202.90/month standard |
| 2026 Deductible | $1,736 per benefit period | $283 per year |
| Coinsurance | $434/day for days 61-90 | 20% after deductible |
| Out-of-pocket max | None | None |
| Automatic enrollment | Yes at 65 if receiving SS | Must actively enroll |
When and How to Enroll in Medicare
Timing your Medicare enrollment correctly is critical. Missing your enrollment window can result in permanent premium penalties that last for the rest of your life.
Your Initial Enrollment Period is a 7-month window centered around the month you turn 65: the 3 months before your birthday month, your birthday month itself, and the 3 months after. This is the best time to enroll and avoids all penalties. USAGov
If you are already receiving Social Security or SSDI benefits at least 4 months before turning 65 you are automatically enrolled in both Part A and Part B. You will receive your red, white, and blue Medicare card in the mail approximately 3 months before your 65th birthday.
Late Enrollment Penalties — Read This Carefully
The Part B late enrollment penalty is severe and lasts for as long as you have Part B. Your monthly premium increases by 10% for each full 12-month period you were eligible but did not enroll. For example if you delayed Part B enrollment for 3 years without qualifying coverage your 2026 premium would be 30% higher — $202.90 plus $60.87 equaling $263.77 per month every month for life. USAGov
The only valid reason to delay Part B without penalty is if you have creditable coverage through an employer or union health plan based on active employment.
Do You Need Both Part A and Part B?
Yes. Part A and Part B work together to cover your healthcare needs. Part A without Part B leaves you with no coverage for doctor visits, outpatient services, or preventive care. Part B without Part A leaves you without hospital coverage.
You also need both Part A and Part B to enroll in Medicare Advantage (Part C) or a Medigap supplement plan.
Filling the Gaps in Original Medicare
Original Medicare covers approximately 80% of your healthcare costs after deductibles. The remaining 20% with no out-of-pocket cap can add up quickly — especially for serious illness, major surgery, or extended hospital stays.
To protect yourself from large unexpected bills you have two main options:
Medicare Supplement Insurance (Medigap) — Private insurance sold by licensed insurers that covers some or all of your out-of-pocket costs under Original Medicare. Monthly premiums vary by plan letter (A through N), age, location, and insurer. Medigap plans must cover the same standardized benefits regardless of which insurer sells them.
Medicare Advantage (Part C) — An alternative to Original Medicare offered by private insurers approved by Medicare. These plans bundle Part A, Part B, and usually Part D together. Medicare Advantage plans generally include various additional benefits not covered by Original Medicare such as routine dental and vision. Many plans offer $0 or low monthly premiums.
Key Takeaways
- Part A covers hospital and inpatient care — most people pay $0 premium if they worked 10+ years
- Part B covers doctor visits and outpatient services — standard premium is $202.90/month in 2026
- Part A deductible is $1,736 per benefit period — Part B deductible is $283 per year
- Original Medicare covers about 80% of costs — there is no out-of-pocket maximum
- Enroll during your 7-month Initial Enrollment Period to avoid permanent lifetime penalties
- Consider Medigap or Medicare Advantage to cover the remaining 20% of costs
Frequently Asked Questions
Does SSDI automatically give me Medicare? Yes — but not immediately. If you receive SSDI disability benefits you automatically become eligible for Medicare after a 24-month waiting period from the date your SSDI benefits begin. You do not need to apply separately. Read our SSDI guide to learn more about how SSDI and Medicare connect.
What is the difference between Medicare and Medicaid? Medicare is federal health insurance based on age or disability regardless of income. Medicaid is a joint federal and state program based on financial need with no age requirement. Some low-income Medicare recipients qualify for both programs simultaneously — called dual eligibility.
Does Medicare cover dental and vision? Original Medicare Part A and Part B do not cover routine dental care, routine vision exams, eyeglasses, or hearing aids. Some Medicare Advantage plans include these benefits. You can also purchase standalone dental and vision insurance.
Can I have Medicare and employer insurance at the same time? Yes. This is called having dual coverage or Medicare as a secondary payer. If you are still working and covered by an employer plan with 20 or more employees your employer insurance pays first and Medicare pays second. Coordinate carefully to avoid coverage gaps.
What happens if I cannot afford the Part B premium? You may qualify for a Medicare Savings Program through your state Medicaid office. These programs help pay some or all of your Part B premium, deductible, and coinsurance if your income is below certain limits.
