Original Medicare Guidance in Plainfield, NJ

What Parts A and B pay for, what they cost in 2026 and where the gaps are

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The Foundation Everything Else Sits On

Before anyone compares Medicare Advantage, Medigap or drug plans, it helps to know the base program well. Original Medicare is Part A and Part B, run directly by the federal government. Every other choice either adds to it or takes over how its benefits are delivered.

Original Medicare is broad. It works with nearly any doctor or hospital that accepts Medicare, with no network and no referrals. It also has real gaps: deductibles, a 20 percent share on most outpatient care, no yearly spending limit and almost no routine dental, vision or hearing coverage.

We explain those rules in plain language, in English or Spanish, so the next decision is easier.

A smiling older woman in a sky blue dress and straw hat waters red and white flowers on the lawn of the historic Drake House in Plainfield

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Part A: Hospital Insurance

Part A pays for inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice and some home health care. Most people do not pay a premium for Part A because they or a spouse paid Medicare taxes for at least ten years of work.

In 2026 you pay a $1,736 deductible for each benefit period before Part A pays for a hospital stay. A benefit period begins when you are admitted and ends after you have been out of the hospital or skilled nursing care for 60 days in a row, so one year can include more than one deductible.

An important detail: if the hospital keeps you under observation, you are an outpatient, and Part B rules apply. Ask the staff about your status, because it affects your costs and whether a later nursing facility stay is covered.

Part B: Medical Insurance

Part B covers doctor visits, outpatient care, lab tests, imaging, durable medical equipment such as walkers, ambulance services and many preventive screenings. The standard premium for 2026 is $202.90 a month, and the annual deductible is $283.

After the deductible, you usually pay 20 percent of the Medicare-approved amount. Higher-income households pay an extra amount on top of the standard premium, set by Social Security based on tax returns from two years earlier.

A yearly wellness visit and many screenings at no cost when your doctor accepts assignment
Flu, pneumonia and hepatitis B shots
Diabetes supplies and some outpatient prescription drugs given in a clinic
Mental health care, including counseling, at the standard share

What Original Medicare Leaves Out

Routine dental care, eyeglasses, hearing aids and long-term custodial care are generally not covered. Most outpatient prescriptions require a separate Part D plan. And because there is no ceiling on the 20 percent share, a serious illness can grow expensive.

That is why most people add something. Some choose a Medigap policy plus a Part D plan. Others choose a Medicare Advantage plan that bundles hospital, medical and usually drug coverage. Our job is to show you how each route works for your situation.

Your Medicare Card and Your Rights

Your red, white and blue card carries a Medicare number that is not your Social Security number. Keep it safe and share it only with your doctors, your pharmacy and a plan you have chosen to join.

You have the right to appeal coverage decisions, to receive notices before services end, and to get information in a language you understand. Plainfield residents can also reach the state and county programs that help with costs.

Talk It Through With Us

Have your prescriptions and the names of your doctors handy. We set what you have now beside the plans we offer and point out where costs and access change. Most conversations run about thirty minutes, and you can take all the time you need afterward. Want to know more about us first? Meet our agency.

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Original Medicare Questions From Plainfield

Can I keep only Original Medicare and nothing else?

Yes, that is allowed. Without Part D you may face a late penalty later, and without a supplement your 20 percent share has no yearly limit, so we explain those risks first.

Do I need to sign up for Part B if I still work?

It depends on your employer's size and coverage. Our turning 65 page explains when delaying Part B is safe.

Does Medicare cover care at Neighborhood Health Services on Myrtle Avenue?

Federally qualified health centers like Neighborhood Health Services Corporation accept Medicare for covered services. We can confirm how a specific plan handles your visits there.

¿Me pueden explicar la Parte A y la Parte B en español?

Sí. Le explicamos cómo funcionan, cuánto cuestan en 2026 y qué no cubren, todo en español.

Will talking with you change my benefits?

No. A review is just information. Nothing changes unless you decide to enroll in a plan.

Reflects 2026 Medicare rules and amounts; reviewed October 31, 2026.