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On a player's turn, they can take the top face down card from the stock, or take the top face up card from the discard pile. After melding, laying off, or making no plays on the table, a player must discard a card face up on the discard pile. The discard pile is spread out, so that the value of all cards is visible. If you see a card that you can use, you may take it, but you must also take all the cards that have been discarded on top of it, and you must play the lowest (physical) card in the deck as soon as you pick it up. If you only take the top card of the discard pile, you do not have to meld it immediately. (Variant: No wait, actually you do.)

The hand ends as soon as one player discards her last remaining card (going out). Cards on the table are worth positive points, and cards left in your hand are worth negative points. Numbered cards from 2-10 are worth their pip value (Variant: 2-9 are worth 5); face-cards are worth 10 points; aces are worth 15 points, unless used in an A-2-3 run; jokers are worth 15 points. (Variant: All players add up the pip values of the cards in their hands, and those points are given to the player who went out.) A player who goes out without previously laying down any cards goes "rummy," and scores double the points. Normally, games are played to 500 points, but players can opt to play to fewer points, or play a specific number of rounds.

When playing with 2, both players get 13 cards. When playing with 3 or 4, each player gets 7 cards. When playing with 5 or 6 players, each player receives 6 cards.

There are many other variations of the game. Early versions of Rummy were often played with a 44-card deck, Ace through 11 in four suits. In the 2-player version players are dealt 8 cards, with 3 or more players, the hand size is 6 cards. considers the overlapping discard pile, from which a player can take any card plus all cards above it in the pile, to be the feature distinguishing Rummy 500 from basic Rummy. However, numerous other optional rules for each variant are also listed, some of which could be considered to be equally significant, and there is no consensus across the web as to what defines one or the other.

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