Medicare Part A vs. Part B: What You Actually Owe

You just turned 65. You enrolled in Medicare. You thought you were covered.

Then you get a bill for $1,200 after a hospital stay. Or $400 for a doctor's visit. Or a confusing statement that says "Medicare paid $X, you owe $Y."

Wait—doesn't Medicare cover everything?

Not quite. Medicare has different parts, and each one covers different things. Here's what you actually owe under Part A and Part B—in plain English.

Medicare Part A: Hospital Insurance

What it covers:

What it costs:

Most people pay $0 premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.

What you pay out-of-pocket:

Hospital Stays (2026 rates):

What's a benefit period?

A benefit period starts the day you're admitted to the hospital and ends when you haven't received inpatient care for 60 consecutive days. If you're readmitted after 60 days, a new benefit period (and new deductible) begins.

Skilled Nursing Facility (2026 rates):

Important: Medicare only covers skilled nursing if:

1. You were in the hospital for at least 3 days

2. You enter the facility within 30 days of leaving the hospital

3. You need skilled care (not just custodial care)

Medicare Part B: Medical Insurance

What it covers:

What it costs:

Monthly Premium (2026):

Standard premium: $174.70/month

Higher earners pay more (based on 2024 tax return):

| Individual Income | Joint Income | Monthly Premium |

|-------------------|--------------|------------------|

| ≤ $103,000 | ≤ $206,000 | $174.70 |

| $103,001-$129,000 | $206,001-$258,000 | $244.60 |

| $129,001-$161,000 | $258,001-$322,000 | $349.40 |

| $161,001-$193,000 | $322,001-$386,000 | $454.20 |

| $193,001-$500,000 | $386,001-$750,000 | $559.00 |

| > $500,000 | > $750,000 | $594.00 |

Annual Deductible (2026):

$240/year

Once you meet this, Medicare pays 80% of approved charges.

Coinsurance:

After your deductible, you pay 20% of the Medicare-approved amount for most services.

Example:

Your doctor charges $200 for an office visit. Medicare's approved amount is $150.

Important: If your doctor doesn't accept Medicare assignment, you could pay more.

Part A vs. Part B: What's the Difference?

| | Part A (Hospital) | Part B (Medical) |

|---|---|---|

| Premium | Usually $0 | $174.70/month (2026) |

| Deductible | $1,632 per benefit period | $240/year |

| Coinsurance | Varies by service | 20% of approved amount |

| Covers | Inpatient hospital, SNF | Doctor visits, outpatient |

What Medicare Doesn't Cover

Even with Part A and Part B, you're still responsible for:

Medigap: Filling the Gaps

Because Medicare doesn't cover everything, many people buy Medigap (Medicare Supplement Insurance) to cover:

Medigap plans are sold by private insurers and have standardized coverage levels (Plan A, Plan G, Plan N, etc.).

Most popular plan: Plan G (covers almost everything except the Part B deductible)

Medicare Advantage (Part C): The Alternative

Instead of Original Medicare (Part A + Part B) + Medigap, you can choose Medicare Advantage.

How it works:

Private insurance companies offer plans that include Part A, Part B, and usually Part D (prescriptions).

Pros:

Cons:

Real-World Example: What You'd Pay

Scenario: You have Original Medicare (Part A + Part B) and need a 5-day hospital stay followed by outpatient physical therapy.

Hospital Stay (Part A):

You pay: $1,632

Follow-up Doctor Visit (Part B):

You pay: $150 (toward deductible)

Physical Therapy (Part B):

You pay: $192 ($90 deductible + $102 coinsurance)

Total out-of-pocket: $1,974

With Medigap Plan G, you'd pay only the $240 Part B deductible.

Key Takeaways

How BillDecoder Helps Medicare Recipients

Medicare billing statements (MSNs) can be confusing. BillDecoder helps you:

You've paid into Medicare your whole career. Make sure you're not overpaying now.

Confused by your Medicare bill? Upload it to BillDecoder for a plain-English breakdown.