DA
David Austin Medicare
Chief Medicare Interpreter
(816) 200-8841Call or text — a real person answers Let's talk

Reference & education

The glossary and the numbers, all in one place.

Tap any term for a plain-English translation, and see the exact 2026 Part A & Part B costs below. This is general education, not plan-specific advice — for that, let's talk.

Medicare, decoded

Tap a term. I'll translate it.

Medicare is full of words designed to make simple things sound complicated. Here's the same idea, said like a human. This is general education — not plan-specific advice.

The basics
Costs
Doctors & networks
Drugs
Enrollment
What they say
Original Medicare
What it means
The government's own coverage — Part A (hospital) and Part B (doctors). You can use almost any provider that accepts Medicare, but on its own it doesn't cap what you pay in a year.

Easy to mix up

The two comparisons everyone confuses

These four terms trip up almost everyone. Side by side, they're simple.

Copay vs. Coinsurance
Copay
A flat fee. $20, every time — you know it up front.
vs
Coinsurance
A percentage. 20% of the bill, however big it gets.
The difference: a copay is a fixed price; coinsurance rides the size of the bill.
HMO vs. PPO
HMO
Lower cost — but stay in-network and usually pick a primary doctor.
vs
PPO
More freedom to go out-of-network — for a higher price.
The difference: HMO trades flexibility for savings; PPO trades savings for flexibility.

What the ads leave out

The gaps in Original Medicare

Parts A and B are a strong foundation — but they were never built to cover everything. Here's what they leave on the table.

1

No prescription drug coverage

Part D is separate

2

No routine dental

Cleanings, work, dentures

3

No routine vision

Exams, glasses

4

No routine hearing

Exams, hearing aids

ORIGINAL MEDICARE PART A PART B
5

No out-of-pocket maximum

Your share can add up

6

You still pay the cost-sharing

Deductibles, copays & 20%

7

Long-term custodial care

Generally not covered

8

Foreign travel emergencies

Very limited coverage

So what fills the gaps?

Many people add coverage to close these gaps — a Medicare Supplement (Medigap), Part D, or a Medicare Advantage plan. Which one fits depends entirely on your situation. That's the conversation I walk you through.

Talk it through with me
Free · no obligation · no pressure
2026 figures

The actual numbers

How Part A & Part B actually work

Original Medicare is two parts. Here's what each one covers — and exactly what you're on the hook for.

Part A
Hospital Insurance
Inpatient hospital, skilled nursing, hospice
Monthly premium
$0
for most people (40+ quarters worked)
A hospital stayYou pay ↓
Days 1–60Your deductible per benefit period
$1,736
Days 61–90Daily coinsurance
$434/day
Days 91+Lifetime reserve days (60 total)
$868/day
Skilled nursing (after a 3-day stay)You pay ↓
Days 1–20
$0
Days 21–100Daily coinsurance
$217/day
The catch
Part A has no out-of-pocket maximum.
Part B
Medical Insurance
Doctors, outpatient care, tests, equipment
Monthly premium
$202.90
standard; more if higher income
Annual deductible
$283
once per year
After you meet the deductibleYour share
Medicare pays
80%
You payOf the approved amount, most services
20%
What Part B covers

Doctor visits, outpatient & hospital treatment, lab tests, preventive care, durable medical equipment, home health, and more.

The catch
No out-of-pocket maximum — your 20% share has no yearly ceiling.
NEW 2026Part D now caps your yearly drug costs at $2,100.
Download the printable guide (PDF)

Standard 2026 figures from Medicare.gov. Higher-income beneficiaries pay adjusted premiums (IRMAA); Part D deductibles and premiums vary by plan.