Medicare Starts With Parts A and B. Everything Else Builds on Top.

Before you compare Medicare Advantage plans or Medigap supplements, you need to understand what Original Medicare actually covers — and where it stops. Most people turning 65 are surprised by both answers.

What Original Medicare Is — and What It Isn't

Original Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services. It has two parts: Part A covers hospital and facility care, and Part B covers outpatient and medical services. Together, they form the foundation every Medicare plan is built on — but they are not a complete coverage solution on their own.

 

Original Medicare Parts A and B in Cincinnati, Ohio work the same way they do everywhere in the country. The federal program is uniform. What varies is what you add to it — and that decision depends on your doctors, your prescriptions, your health history, and your financial situation.

What Medicare Part A Covers

Part A is your hospital coverage. It pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health services.

 

What most people don't realize until we walk through it together is how the cost structure works. Part A doesn't charge a monthly premium for most people — but it does carry a deductible per benefit period, not per year. In 2024, that deductible is $1,632 per benefit period. After day 60 of a hospital stay, coinsurance kicks in. After day 90, costs escalate further.

 

Skilled nursing facility coverage under Part A is limited to 100 days per benefit period — and only days 1 through 20 are fully covered. Days 21 through 100 carry a daily coinsurance charge. After day 100, Part A pays nothing.

 

This is not a system designed to cover extended illness or long-term care. It is designed for acute, short-term treatment. Understanding that distinction is where Medicare planning actually begins.

What Medicare Part B Covers

Part B is your medical coverage. It pays for doctor visits, outpatient procedures, diagnostic tests, preventive care, durable medical equipment, and most medically necessary services you receive outside of a hospital.

 

Part B covers 80% of the Medicare-approved cost for most services — after you meet the annual deductible, which is $240 in 2024. You pay the remaining 20%.

 

That 20% sounds manageable until you do the math on a serious diagnosis. A major surgery, a cancer treatment course, or a cardiac event can generate hundreds of thousands of dollars in approved charges. Twenty percent of that number is not a rounding error. And here is the detail that catches nearly every new Medicare enrollee off guard: Original Medicare — Parts A and B combined — has no out-of-pocket maximum. Your exposure is unlimited.

 

That gap is not a flaw in the system. It is the design. And it is exactly why most people need something beyond Original Medicare.

The Gap No One Tells You About Until It's Too Late

Original Medicare covers approximately 80% of approved medical costs. The remaining 20% — with no cap — is your responsibility unless you have additional coverage in place.

 

For a healthy 65-year-old with routine medical needs, that exposure may feel theoretical. For someone managing a chronic condition, recovering from surgery, or facing a serious illness, it can mean tens of thousands of dollars in out-of-pocket costs with no ceiling in sight.

 

This is the gap we close in every Medicare planning conversation. Not by steering you toward one plan or another — but by showing you the full picture first, so the decision you make is based on your actual situation.

 

The options for closing this gap are Medicare Supplement (Medigap) plans, Medicare Advantage plans, and Medicare Part D for prescription drug coverage. Each works differently. Each has trade-offs. We walk through all of them.

 

You can learn more about each option on our Medicare Advantage, Medicare Supplement, and Medicare Part D pages, or explore long-term care planning if extended facility coverage is a concern.

When to Enroll — and What Happens If You Miss the Window

Your Initial Enrollment Period is a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and extends 3 months after. This is your first and most consequence-free opportunity to enroll in Medicare Parts A and B.

 

Missing this window without qualifying creditable coverage — typically active employer coverage through a current job — can result in permanent late enrollment penalties. The Part B penalty adds 10% to your premium for every 12-month period you were eligible but didn't enroll. That penalty stays with you for the rest of your life.

 

Enrollment timing is one of the most common sources of anxiety we hear from people approaching 65. It is also one of the most preventable mistakes. We track enrollment windows for every client we work with, and we start that conversation well before the deadline arrives — not after.

Why 450+ Clients Start Their Medicare Planning Here

We have been doing this for 27 years. In that time, we have seen what happens when people choose a Medicare plan before they understand what Original Medicare actually provides — and we have seen what happens when they get the full picture first.

 

The difference is not just financial. It is the confidence of knowing your coverage was chosen deliberately, not by default.

 

We are licensed to shop and compare plans across 24+ carriers. There is no fee to you — we are paid by the carriers. Our job is to find the right fit for your situation, not to push a plan that works for everyone.

 

  • 27 years in business serving the Cincinnati tri-state area
  • Licensed across 24+ Medicare carriers — no fee to the client
  • Certified Social Security Strategist on staff
  • 450+ clients served; $50M+ in assets processed through our office
  • Virtual meetings available for clients outside the Cincinnati area

Most People Leave That First Call With Answers They Didn't Know They Needed

Most people come to us with questions they didn't know they had until we started talking. That's exactly the right place to start. One conversation covers Original Medicare, the gaps, and every option for filling them — at no cost to you.

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Frequently Asked Questions About Original Medicare

  • What is the difference between Medicare Part A and Medicare Part B?

    Part A is hospital coverage — it pays for inpatient stays, skilled nursing facility care up to 100 days, hospice, and some home health services. Part B is medical coverage — it pays for doctor visits, outpatient care, preventive services, and durable medical equipment. Both parts together make up Original Medicare. Neither covers prescription drugs, routine dental, routine vision, or hearing.

  • What does Original Medicare cover in Ohio?

    Original Medicare Parts A and B cover the same services in Ohio as they do in every other state — the federal program is uniform nationwide. Part A covers inpatient hospital and facility care. Part B covers outpatient and medical services at 80% of the approved cost after the annual deductible. What varies is which supplemental plans are available in your area and which carriers serve your zip code.

  • Does Original Medicare cover prescription drugs?

    No. Original Medicare Parts A and B do not include prescription drug coverage. To cover outpatient prescriptions, you need to enroll in a standalone Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage. Skipping drug coverage when you first become eligible can result in a late enrollment penalty if you go without creditable drug coverage for 63 or more consecutive days.

  • Does Original Medicare have an out-of-pocket maximum?

    No. This is one of the most important things to understand before making any Medicare decision. Original Medicare — Parts A and B combined — has no annual out-of-pocket maximum. Your 20% coinsurance under Part B is uncapped, and Part A carries its own deductible and coinsurance structure. This unlimited exposure is the primary reason most people add either a Medicare Supplement plan or a Medicare Advantage plan, both of which include out-of-pocket limits.

  • Can I use Original Medicare alone without a supplement or Advantage plan?

    You can — but it carries meaningful financial risk. Without additional coverage, you are responsible for the Part B deductible, 20% of all approved outpatient costs with no cap, and Part A coinsurance after the first 60 days of a hospital stay. For someone with significant savings who is comfortable with that exposure, it may be a deliberate choice. For most people, the risk is not worth it. We walk through this comparison with every client so the decision is made with full information.

  • Does Medicare Part A cover nursing home costs long-term?

    Not in the way most people expect. Part A covers skilled nursing facility care for up to 100 days per benefit period — and only when you meet specific clinical criteria following a qualifying hospital stay of at least three days. It does not cover custodial care, which is the kind of ongoing assistance with daily living that most people picture when they think of a nursing home. Long-term nursing home costs are not covered by Original Medicare. That gap is addressed through long-term care planning, which is a separate conversation we have with many of our clients.