Original Medicare

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If you’re newly eligible for Medicare, you’re probably wondering how Original Medicare benefits work. Maybe you’re preparing to retire, or you’re about to celebrate your 65th birthday; either way, you’ll need to make decisions about your Medicare. Not only are there dozens of plans and coverage types, but Medicare has strange terminology. Below we provide you with the information needed to understand how your Original Medicare benefits work.

How Does Medicare Work?

Medicare coverage can begin when you’re 65 or after 24 months of disability. Over 10,000 people enroll in Original Medicare each day.Sure, Medicare is Part A and B. But, what does it cover? How do you enroll? Will you need Medigap insurance?

We can answer all these questions and more!

Part A

Medicare Part A vs Medicare Part B Coverage Summary
First, let’s discuss the first part. Part A is your inpatient coverage. So, a hospital visit or hospice care would fall under Part A.

Many people get premium-free Part A, but some pay for this coverage. The premium depends on the amount of time you contribute to Medicare taxes.

Those that don’t meet the requirements for premium-free Part A must pay either $458 or $252 depending on the length of time you contribute to Medicare.

Next, Medicare only covers Part A services at 80% after you meet the deductible. A new benefit period starts when you’ve been out of an inpatient facility for 60 days or more.

Further, there are extra costs associated with staying in a hospital or skilled nursing facility for an extended length of time.

Long term care is NOT part of Medicare benefits. There are many services Medicare doesn’t cover.

Tip: Most Medigap Plans cover the Part A deductible!

Part B

Part B is the outpatient portion of Medicare. While Part A is premium-free, Part B has a monthly premium based on income.

For outpatient services, Medicare covers 80% after you meet the annual deductible. The Part B deductible is a once per year amount.

Most doctors accept Original Medicare, but in some states, they can impose excess charges.

Those in need of Durable Medical Equipment, ambulance services, doctor visits, lab tests, or health screenings can expect Part B to provide coverage.

Tip: Medicare Supplement Plans can cover the portion of the bill you’d be responsible for paying.

What are the Qualifications for Medicare

If you’re turning 65 or have been on disability for at least 24 months, you’re likely eligible for Medicare. Those with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease may not need to wait 24 months for coverage to begin.

How to Determine Medicare Eligibility

  • Date of birth + original birth certificate
  • Marital status + original marriage certificate
  • Legal residency
  • Immigration documents like a green card
  • Social Security number
  • Any evidence of current employer coverage

How to Sign Up for Original Medicare

There are several ways to sign up for Medicare. Oddly enough, you’ll be enrolling in Medicare through Social Security.To apply for Medicare by phone, call Social Security’s main phone number. Then, schedule an interview.

Also, you can apply online at any time through the Social Security website.

Those that prefer to apply in person can call Social Security and make an appointment for an in-person interview at a local office.

If you need to contact your local office directly, you can look the number up in a phone book or by visiting the Social Security’s website and finding your local office with the “locator” option.

Tip: If you secure an appointment before the date, you won’t have to wait in line.

Generally, you can pick one of these three periods to enroll:

  1. Initial Enrollment Period: occurs around the age of 65
  2. Special Enrollment Period: Those that delay enrollment past age 65 with employer health coverage or changes in coverage.
  3. General Enrollment Period: Runs from January 1st to March 31st annually, during this time you may sign up if you didn’t do so when you should’ve. Delaying Part B enrollment will result in a late enrollment penalty.

Anyone outside of a Medicare enrollment period, you may need to wait until the General Enrollment Period comes back around. For people that delay enrollment, Medicare costs can be higher due to penalties.

Understanding Medicare Premiums

Many people think that Medicare is free, yet, you’ll likely pay a monthly premium for coverage. But, Part A is free for most people.

Most people pay a standard premium for Part B. But, you may pay more if your income is above a certain amount.

The cost of Medicare depends on your specific situation; income, plan choice, and applicable late enrollment fees.

Tip: Don’t judge a policy by the premium, talk with an agent to find the plan that brings you the most value.

Common Questions About Original Medicare

What is Original Medicare?
Original Medicare provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services. Original Medicare is a fee-for-service plan that’s managed by the federal government.
Why does Medicare exist?
Medicare exists to provide health coverage to those who at least 65 years old, as well as those collecting Social Security disability income.
How do I know if I have Original Medicare?
A good way to know if you have Original Medicare is to check your social security check. Those collecting Social Security will automatically be enrolled in Original Medicare. You’ll see the monthly premium come out of your Social Security benefits check. You can also check your status online at www.mymedicare.gov or call Medicare directly.
How old do you have to be to get Medicare?
Most people get Medicare at age 65. But, those with disability for 24 months can be eligible at any age. Anyone with ALS or ESRD will qualify before age 65 without waiting for two years.
Who is not eligible for Medicare?
You aren’t eligible for Medicare if you’re not a United States citizen and haven’t been a resident of the United States for at least five years. Or if you’re younger than 65 with no disabilities.

You won’t get free Part A unless you contribute to Medicare taxes for about ten years. Otherwise, you’ll pay for Part A.

If preferable, you can enroll in Part B only at age 65 without buying Part A. But, joining in Part A means you must register in Part B.

You must have Part A and B to buy a Medigap policy or a Medicare Advantage plan. But, if you only have Part A or B, you can still select Part D.

What parts of Medicare are mandatory?
Once you enroll in Social Security, Part A is mandatory. But, Part B, C, and D are not mandatory.

If you delay Part B or Part D and don’t have creditable coverage, you could get penalized.

How to Get Help Understanding Original Medicare

When you call one of our agents, they’ll ask you a series of questions to better identify your policy match. Then, they can compare all the top-rated carriers in your service area to find the best option. Not only do we consider cost, we know the value of going with a stable carrier. Plus, we take into consideration the past rate increases.

Some companies are notorious for offering low upfront premiums, and higher rate increases. You don’t want to find yourself caught up in their bait and switch tactics.

Instead, give our agents a call at the number above. Then, you’ll see why many seniors trust us with their insurance needs. We have your back long after enrollment. Our Client Care Team commits to making sure our customers have good experiences for years to come.

If calling now isn’t an option, fill out our online rate form to get the process going. Once complete, an agent will be in contact with you to provide free expert advice.

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