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Original Medicare


If you’re soon-to-be eligible for Medicare, you’re probably wondering what Original Medicare is. Whether you’re preparing to retire or about to celebrate your 65th birthday, you’ll need to make decisions about your Medicare soon. Not only are there dozens of plans and coverage types, but Medicare has unique terminology. Below, we provide you with the information needed to understand what Original Medicare is and how your benefits work.

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.

Medicare Part A vs Part B

Part A is your inpatient coverage. So, a hospital visit or hospice care would fall under Part A. For many people, Part A is premium-free, but some pay for this coverage. The premium depends on how long you’ve contributed to Medicare taxes.

Medicare only covers 80% of Part A services after you’ve met the deductible. A new benefit period starts when you’ve been out of an inpatient facility for 60 days or more. Part B is the outpatient portion of Medicare. You’ll use Part B at doctors’ offices.

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.

Medicare Part A vs Part B Coverage Summary

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 Medicare to start.

How to Enroll in Original Medicare

You’ll be enrolling in Medicare through Social Security. You can apply for Medicare via phone, online through the Social Security website, or in person.

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

  1. Initial Enrollment Period: This occurs when the beneficiary turns 65.
  2. Special Enrollment Period: Qualifying life events that allow you to make changes to your Medicare coverage.
  3. General Enrollment Period: Runs from January 1 to March 31 annually. During this time, you may sign up if you didn’t do so during your Initial Enrollment Period. Delaying Part B enrollment will result in a late enrollment penalty.

Understanding Medicare Premiums

Many people think that Medicare is free. In reality, you’ll likely pay a monthly premium for coverage. Though Part A is free for most people, most people also pay a standard premium for Part B. 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.

FAQs

Why does Medicare exist?
Medicare exists to provide health coverage to those at least 65 years old, and 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 look at your social security check deductions. 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 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 collecting SSDI benefits for at least 24 months can be eligible at any age. Anyone with ALS or ESRD will qualify before age 65 without having to wait.
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.
What documents do I need to apply for Medicare?
To apply for Medicare you’ll need proof of citizenship or legal residency, a birth certificate, and your driver’s license.
Do you need a primary care doctor with Medicare?
You don’t have to select a Primary care doctor with Medicare. But, to keep your costs lower you’ll want to use a doctor that accepts Medicare assignment.
Do I need a referral to see a specialist with Medicare?
With Original Medicare, you don’t need a referral to see a specialist. But, you’ll want to see a specialist that at least accepts Medicare assignment.

How to Get Help Understanding Original Medicare

We hope the above information was helpful. We're here as a resource to help you better understand all aspects of Medicare. Original Medicare doesn't cover everything. Part A and Part B both leave 20% of costs uncovered for you to pay out-of-pocket.

However, Medicare Supplement or Medigap plan will pay for what Medicare doesn’t. To find out more about Medicare Supplements, call the number above.

One of our agents will ask you a series of questions to better identify your policy match. Then, they can compare all the top Medicare insurance companies in your service area to find the best option. You’ll see why many seniors trust us with their insurance needs.

We have your back long after enrollment. Our Client Care Team ensures our customers have a great experience for years to come. We can answer all your Medicare questions. If calling now isn’t an option, fill out our online rate form to start the process. An agent will be in contact with you to provide free expert advice.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

3 thoughts on “Original Medicare

  1. Hi, can you advise how I can get some extra help to cover my Part B payment, my doctors’ copays as well as my prescription drugs costs.
    I receive a monthly Social Security of $633. and have been missing my appointments often. Last month I went without the medication Niacin 1000mg. because I could not pay for the increased cost. I also pay $54.00 monthly for my United Health Care Advantage plan.

  2. What makes a group health plan with less than 20 employees qualify as creditable coverage? I was 65 in April 2021 and delayed Medicare as I was covered under a large group plan (more than 20 employees). That coverage expired Aug 31, 2021. I moved to another state but have exceptional coverage under a new employment plan that exceeds Medicare coverage. Does that qualify the plan to be creditable? What questions should I be asking or what forms should I be requesting?

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