Original Medicare Parts

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Original Medicare

What is Original Medicare? It’s a federal health insurance program. Eligibility begins with an individual turning 65, or after 24 months on disability (regardless of age) for a qualifying ailment. It has four separate parts; A, B, C, and D.

  1. Part A will be the hospital coverage
  2. Part B will be the doctors’ coverage
  3. Part C is Medicare Advantage, or “Managed Care” (i.e. HMOs, PPOs, PFFS, and SNP)
  4. Part D is your Rx coverage, or Prescription Drug Plans (PDP). Some of these parts work together, some do not

Be sure to understand which plans/parts work together, and which ones do not.

Part A

Part A, Hospital Coverage, is generally offered at no additional cost to qualifying individuals who have at least forty calendar quarters, ten years, of employment in any job in which Social Security taxes were paid for in the United States.

You are eligible if you qualify for Railroad Retirement benefits, if you were a federal employee after Dec. 31, 1982, or a state or local employee after Mar. 31, 1986. The cost for Part A otherwise could cost you over $400 per month. Part A (Hospital) covers most medically necessary hospital, skilled nursing facility, hospice care, and home health. Part A is not full coverage. It will have a reoccurring deductible and other out of pocket expenses.

Please view this chart for a more complete breakdown:

Part B

Part B, Doctors and Outpatient services, is optional coverage that requires a premium to be paid monthly. The premium will be based on, up to, the previous two years of annual income. (See Income Chart) Medicare Part B covers most medically necessary doctors’ services, hospital out-patient services, durable medical equipment, preventive care, lab test, x-rays, mental health care, and some ambulance charges. Part B is not full coverage. There is still a deductible to be met and other out of pocket expenses.

Please view this chart for a more complete breakdown:

Part C

Part C, or Medicare Advantage, is the part of Medicare that allows private health insurance companies to provide one Medicare benefit option. Medicare private health plans are known as HMOs, PPOs, PFFS, and SNP. You can choose to get your Medicare coverage through a Medicare Advantage plan instead of traditional Medicare, but you cannot have both. You cannot have Medicare Parts A and B with Part C.

Medicare Advantage plans must offer at least the same benefits as Parts A and B but can do so with different costs, rules and coverage restrictions. There are many choices for Medicare Advantage plans, which are identified by an approved area Network. It’s possible to pay a monthly premium for this coverage, in addition to your Part B premium. Enrollment outside of your Open Enrollment is typically between Oct. 15th through Dec. 7th of each year, or Annual Enrollment Period (AEP).

Part D

Part D, or Prescription Drug Plans (PDPs), is the part of Medicare that provides prescription drug coverage. Medicare Part D Plans are provided only through private insurance companies that have legal agreements with the government; it’s never provided directly from the government. If you want Part D, you must choose Part D coverage that works with your Medicare health benefits.

If you have traditional Medicare, choose a stand-alone Part D plan. Enrollment outside of your Open Enrollment is typically between Oct. 15th through Dec. 7th of each year, or Annual Enrollment Period (AEP). If a Part D plan is not picked up when eligible you will be penalized 1% each month you could have had the plan, and didn’t. This penalty will be paid separately to Medicare if you enroll in a Part D plan in the future.

There are three phases of coverage to understand with this type of coverage. The three phases are the Initial Coverage, Donut-Hole, and Catastrophic. It’s important to understand these phases, particularly if you find yourself requiring high cost for your prescribed medication.

Additional Information

For more information on any of the plans listed above please call the number above or fill out our contact form. If you’re shopping for rates in your area you can fill out our compare rates form to see the rates side by side with the top carriers.