Understanding Original Medicare (Parts A & B) for veterans

Original Medicare is the original, government-run, fee-for-service Medicare benefit that has been in place since 1965. When you hear "Medicare," most people are picturing Original Medicare (Parts A and B). It is the foundation that TRICARE For Life is designed to wrap around.

Part A — Hospital insurance

Part A is your hospital benefit. It covers care you receive as an admitted inpatient — not the outpatient or doctor's office work that Part B covers.

What Part A covers:

• Inpatient hospital stays. Semi-private room, meals, general nursing, drugs given as part of inpatient treatment, and other hospital services and supplies during an admitted stay.
• Skilled nursing facility (SNF) care. Up to 100 days per benefit period, only after a qualifying inpatient hospital stay of at least 3 days. SNF is for skilled recovery (physical therapy, IV antibiotics, wound care), not custodial care.
• Hospice care. End-of-life care for people with a terminal illness expected to last 6 months or less.
• Some home health care. Limited part-time skilled nursing and therapy at home, ordered by a doctor.
• Inpatient mental health care. Including a lifetime cap of 190 days in a freestanding psychiatric hospital.

What Part A costs in 2026 (subject to annual update by CMS):

TFL's role with Part A: For care covered by both Medicare and TFL, TFL pays the Medicare cost-shares above. That includes the hospital deductible, coinsurance, and SNF coinsurance for any portion that Medicare itself does not pay. Your typical out-of-pocket: $0.

Part B — Medical insurance

Part B is your outpatient benefit — everything that happens outside an inpatient hospital admission.

What Part B covers:

• Doctor and specialist visits (primary care, cardiology, dermatology, etc.)
• Outpatient hospital services (same-day surgery, observation stays, ER visits not converted to inpatient)
• Preventive services — annual wellness visit, flu and COVID vaccines, cancer screenings (mammogram, colonoscopy, prostate, lung), cardiovascular screenings, diabetes screening, depression screening, and more
• Durable medical equipment (DME) — wheelchairs, walkers, hospital beds, CPAP machines, oxygen, blood-glucose monitors
• Ambulance services
• Outpatient mental health services
• Limited outpatient prescription drugs — drugs administered in the doctor's office, such as chemotherapy infusions
• Physical therapy, occupational therapy, and speech-language pathology

What Part B costs in 2026:

IRMAA — Income-Related Monthly Adjustment Amount. If your modified adjusted gross income (MAGI) two years ago exceeded certain thresholds (around $103,000 single / $206,000 joint in 2024), SSA charges you a higher Part B premium. IRMAA brackets are published annually by SSA.

TFL's role with Part B: For care covered by both Medicare and TFL at a participating provider, TFL pays the Part B deductible and 20% coinsurance. Your typical out-of-pocket: $0.

Why Part B is non-negotiable for TFL beneficiaries

This is the single most important rule on this page. The TFL Handbook states it plainly: you must be enrolled in Medicare Parts A and B to be eligible for TRICARE For Life. There is no exception, no waiver, no military discount.

Practical consequences if you drop or fail to enroll in Part B:

• You lose TFL coverage the same day Part B ends.
• You cannot re-enroll in Part B until the next General Enrollment Period (January 1 – March 31), with coverage starting the following month.
• A permanent 10% per-year late-enrollment penalty is added to your Part B premium for as long as you have Medicare.
• The MTF will not fill the gap — once you lose TFL, the MTF can only see you on a space-available basis.

Original Medicare has no network

Unlike a Medicare Advantage plan, Original Medicare has no provider network and no referrals. Any U.S. doctor, specialist, or hospital who accepts Medicare can see you, anywhere in the country. This is one of the biggest advantages of Original Medicare + TFL for retirees who travel, snowbird, or live in rural areas.

What Original Medicare does NOT cover

A few notable gaps. Original Medicare does not cover:

• Routine dental care (cleanings, fillings, crowns, dentures)
• Routine vision care (eye exams for glasses, glasses themselves)
• Hearing aids and routine hearing exams
• Long-term custodial care (nursing-home room and board for non-skilled care)
• Most care outside the United States
• Routine foot care, cosmetic surgery, and most non-medically-necessary services

TFL also does not cover routine dental, vision, hearing, or long-term custodial care. These are the gaps that lead some veterans to consider FEDVIP or a Medicare Advantage plan (see Lesson 11).

Continue learning

— suggested by the knowledge graph

Lessons

• Frequently asked questions about Medicare and TRICARE For LifeA quick-reference summary of the questions retired service members and spouses ask most often — with citations to the official source.
• Common mistakes retired military make at 65 — and how to avoid themThe most expensive errors retired service members and spouses make during the Medicare and TFL transition, and the simple fixes for each.
• How Medicare and TRICARE For Life work togetherThe exact mechanics of who pays first, who pays second, and what you owe — for every common care scenario.

Encyclopedia

• Medicare Part AThe hospital insurance side of Original Medicare — covers inpatient stays, skilled nursing, hospice, and some home health.
• Medicare Part BThe medical insurance side of Original Medicare — covers doctor visits, outpatient care, preventive services, and durable medical equipment.
• Medicare Part C (Medicare Advantage)An optional, all-in-one alternative way to get your Medicare benefits — delivered through a private plan instead of through Original Medicare.
• TRICARE For Life (TFL)The wraparound secondary health coverage for Medicare-eligible military retirees, spouses, and survivors — no premium, no enrollment fee.
• Initial Enrollment Period (IEP)The 7-month window around your 65th birthday when you first sign up for Medicare Parts A and B without penalty.
• General Enrollment Period (GEP)The January 1 – March 31 window each year when you can sign up for Medicare if you missed your IEP and don't qualify for an SEP.
• Medicare AssignmentA provider's agreement to accept Medicare's approved amount as full payment for a covered service.
• Military Treatment Facility (MTF) & Space-Available CareDoD military hospitals and clinics — at 65, retirees can only be seen if appointments aren't needed by active duty or TRICARE Prime enrollees.
• FEDVIPOptional dental and vision insurance retired military can buy through BENEFEDS — fills the dental/vision gap in Medicare and TFL.
• HMO vs PPO (Network)Two common Medicare Advantage plan structures — HMOs require in-network care, PPOs allow out-of-network at higher cost.

FAQs

• How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $202.90/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
• I'm still working past 65. Can I delay Part B?Only if you have true employer group health coverage from active employment (yours or your spouse's, 20+ employees). In that case you get a Special Enrollment Period later. But TFL won't activate until you take Part B.
• Do I need Medicare Part A if I have TRICARE?Yes. TFL requires Part A and Part B. Part A is typically premium-free if you or your spouse worked 40+ quarters paying Medicare taxes.
• What is the 5-star Special Enrollment Period?A one-time-per-year chance (Dec 8 – Nov 30) to switch into a 5-star-rated Medicare Advantage or Part D plan in your area, outside the normal enrollment windows.
• Can I get a Part B giveback and keep TRICARE For Life?Yes. Enrolling in a Medicare Advantage plan with a Part B giveback lowers your premium, and TFL stays intact as a wraparound for in-network MA care.
• I just retired and my income dropped. Can I lower my IRMAA?Yes. File SSA Form SSA-44 and provide proof of a 'life-changing event' (retirement, work stoppage, divorce, death of spouse, loss of pension, employer settlement).