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?
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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.
Tip: Most Medigap Plans cover the Part A deductible!
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
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:
- Initial Enrollment Period: occurs around the age of 65
- Special Enrollment Period: Those that delay enrollment past age 65 with employer health coverage or changes in coverage.
- 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
How to Get Help Understanding Original Medicare
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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.
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