If you are reaching Medicare eligibility, you are probably wondering what Original Medicare consists of. Whether you are preparing to retire or about to celebrate your 65th birthday, you will need to make decisions about your Medicare coverage soon. Not only are there dozens of plans and coverage types available, but Medicare has unique options making it important to choose the best coverage for you. Below, we provide you with the information needed to understand what Original Medicare is and how your benefits work.
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What is Original Medicare?
Original Medicare was signed into law by President Johnson in 1965. Original Medicare provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services at medical facilities nationwide and is a fee-for-service plan that is managed by the federal government.
Since its inception in 1965, Original Medicare has consisted of the same two parts. Medicare Part A and Medicare Part B. For more than 50 years, Original Medicare has provided coverage for Seniors and Americans with disabilities.
With Original Medicare, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare.
Original Medicare: Medicare Part A vs. Medicare Part B
Medicare Part A provides hospital inpatient coverage. This means hospital visits, hospice care, and home health care all falls under the Original Medicare umbrella.
For many beneficiaries, Medicare Part A is premium-free, but some pay for this coverage. The premium depends on how long you’ve contributed to Medicare taxes.
Original Medicare only covers Medicare Part A services after you’ve met the per occurrence deductible. A new occurrence or benefit period starts when you’ve been out of an inpatient facility for 60 days or more.
Medicare Part B is the outpatient portion of Original Medicare. Medicare Part B benefits can be utilized at the doctor’s office or for approved durable medical equipment.
While Medicare Part A is premium-free for most, Medicare Part B has a monthly premium based on income.
For outpatient services, Original Medicare covers 80% after you meet the annual deductible.
What Are the Qualifications for Original Medicare?
If you are an American citizen turning 65 or have been on disability for at least 24 months, you are likely to be eligible for Original Medicare. Additionally, those with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease are eligible for Medically immediately following their diagnosis.
Understanding Original Medicare Premiums
Each month, you’ll likely pay a standard premium for Medicare Part B coverage. However, if your income exceeds a certain amount, you may pay a larger monthly premium. The cost of Medicare depends on your situation, income, plan choice, and applicable late enrollment fees.
How to Enroll in Original Medicare
Original Medicare enrollment is done through your local Social Security office. You can apply for Original Medicare via phone, online through the Social Security website, or in person.
Generally, you can pick one of these three periods to enroll:
- Initial Enrollment Period: This occurs when the beneficiary turns 65.
- Special Enrollment Period: Qualifying life events that allow you to make changes to your Medicare coverage.
- 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 may result in a late enrollment penalty.
FAQs
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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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Parts of Medicare, Medicare. Accessed March 2022.
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare - An Overview of Medicare, KFF. Accessed March 2022.
https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/ - Original Medicare, CMS. Accessed March 2022.
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
You should receive a letter from Medicare when/if ever your coverage dips below ‘credible’. Then if it does fall below ‘credible’, you must enroll in a Part D for prescriptions or be penalized if and when you ever do enroll in a Part D, under some circumstances. Low Income Subsidies qualifications result in a waiver of penalty. Social Security determines LIS qualifications that subsidizes drug costs. Some Medicare Advantage Plans cover Part D and include A, B,and C, as well as other coverages such as dental, vision and hearing.
Yes, this information is correct! Thank you for sharing.
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.
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?
Hi JR! We discuss this top over on our Medicare & employer coverage FAQ. It also has the forms you will need to complete once you lose employer coverage. Your best option is to reach out to your benefits administrator as they would know if the coverage is creditable under Medicare.