Orlando Harmon
Original Medicare is federal health insurance for anyone aged 65 and over, as well as some people under 65 with certain disabilities or conditions. Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Most people get Part A for free, but some have to pay a premium for this coverage. Part B usually requires a premium. Original Medicare covers inpatient hospital care, doctors' services and tests, and preventive services. However, it does not cover everything, and some services like long-term care, dentures, and routine physical exams are excluded.
| Characteristics | Values |
|---|---|
| Name | Original Medicare |
| Type | Federal health insurance |
| Eligibility | Individuals aged 65 and older, and some people under 65 with certain disabilities or conditions |
| Coverage | Inpatient hospital care, doctors' services and tests, and preventive services |
| Cost | Pay for services as you get them; Medicare pays part of the cost, and you pay your share |
| Enrollment | Individuals must sign up for Part A (Hospital Insurance) and Part B (Medical Insurance) |
| Supplemental Coverage | Medicare Supplement Insurance (Medigap), Medicaid, employer or union coverage, retiree coverage |
| Drug Coverage | Optional; Medicare drug coverage (Part D) is available to everyone with Medicare |
| Exclusions | Long-term care, dentures, routine physical exams, dental services, vision, hearing |
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What You'll Learn
Medicare Part A (Hospital Insurance)
Medicare Part A, also known as Hospital Insurance, is one of the components of Original Medicare. It covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. It also includes coverage for behavioural and mental health services.
Most people are eligible for premium-free Part A, but this requires meeting certain conditions. To qualify for free Part A, an individual must be entitled to receive Medicare based on their earnings or those of a spouse, parent, or child. Additionally, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The number of required QCs depends on the basis of eligibility, whether it is age, disability, or End-Stage Renal Disease (ESRD). QCs are earned by paying payroll taxes under the Federal Insurance Contributions Act (FICA) during an individual's working years.
For those who do not qualify for premium-free Part A, there is still an option to enrol by paying a premium. Individuals who want to enrol in Part A must do so through the Social Security Administration. Coverage under Part A begins the month an individual turns 65, provided they file an application within 6 months of their 65th birthday. If the application is submitted after this 6-month period, Part A coverage will be retroactive for 6 months.
It is important to note that Original Medicare, including Part A, does not cover all medical expenses. Some services that are not covered include long-term care, dentures, and routine physical exams. Additionally, for those who choose Original Medicare and want to add drug coverage, a separate Medicare drug plan can be purchased.
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Medicare Part B (Medical Insurance)
Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Medicare Part B helps cover two types of services: medically necessary services and preventive services. Medically necessary services are services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition. Preventive services are healthcare services that prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best. You pay nothing for most preventive services if you get them from a healthcare provider who accepts assignment.
If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin. If you use an insulin pump that's covered under Part B's durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month's supply of Part B-covered insulin for your pump cannot be more than $35.
Most people get Part A for free, but some have to pay a premium for this coverage. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person's working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Individuals who do not enroll in Part B or premium Part A when first eligible because they were performing volunteer service outside of the United States for at least 12 months on behalf of a tax-exempt organization and had health insurance that provided coverage for the duration of their volunteer service may enroll using a Special Enrollment Period (SEP). The SEP is a 6-month period that begins the earlier of the first day of the month following the month for which the individual was no longer serving as a volunteer outside of the United States.
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Eligibility and enrolment
Original Medicare is the country's health insurance program for people aged 65 or older or with certain disabilities or permanent kidney failure. It includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Eligibility and Enrollment
Medicare Part A and Part B are available to individuals aged 65 or older. If you are under 65, you may be eligible for Medicare if you have permanent kidney failure or receive disability benefits.
Most people get Part A for free, but some have to pay a premium. To be eligible for premium-free Part A, you must be entitled to receive Medicare based on your own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A based on age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during an individual's working years.
Individuals who must pay a premium for Part A do not automatically get Medicare when they turn 65. They must file an application to enroll by contacting the Social Security Administration and must also enroll in or already have Part B. To keep premium Part A, the individual must continue to pay all monthly premiums and stay enrolled in Part B.
Individuals who are eligible for premium-free Part A are also eligible to enroll in Part B once they are entitled to Part A. Individuals who must pay a premium for Part A and want to enroll in Part B must meet additional requirements, including being a U.S. resident and citizen or a lawfully admitted permanent resident who has resided in the U.S. for 5 continuous years prior to filing an application for Medicare.
Individuals who are already receiving Social Security or RRB benefits at least 4 months before being eligible for Medicare and residing in the United States (except Puerto Rico) are automatically enrolled in both premium-free Part A and Part B. People who are automatically enrolled have the choice to keep or refuse Part B coverage. Those who were not automatically enrolled, including individuals not receiving Social Security or RRB benefits, may enroll in Part B during certain enrollment periods.
There is an 8-month Special Enrollment Period to sign up for Part B that starts when you stop working or lose your job-based health coverage. If you want Medicare coverage to start when your job-based health insurance ends, you need to sign up for Part B the month before you plan to retire. Your coverage will start the month after Social Security or the Railroad Retirement Board receives your completed forms.
Individuals who do not enroll in Part B or premium Part A when first eligible due to volunteering outside of the U.S. or incarceration may enroll using a Special Enrollment Period (SEP). The SEP for volunteering is a 6-month period that begins the earlier of the first day of the month following the month an individual is no longer serving as a volunteer outside of the U.S. The SEP for incarceration is a 12-month period that begins on the day an individual is released from custody.
Individuals who are 65 or older can enroll online for Parts A and B, or Part A only. You can delay Part B if you already have coverage through an employer group health plan.
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Medicare Advantage Plan
Original Medicare, which includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), is administered by Medicare. Once you have signed up for Part A and Part B, you can choose to get your coverage from Original Medicare or a Medicare Advantage Plan.
A Medicare Advantage Plan is a type of Medicare health plan that provides Part A and Part B benefits to people with Medicare. These plans are typically offered by private companies that contract with Medicare and must follow rules set by Medicare. They are sometimes referred to as "Part C" or "MA plans".
It is important to note that joining a Medicare Advantage Plan may cause you to lose your employer or union coverage, which could also affect your spouse and dependents. Additionally, a Medicare Advantage Plan can disenroll you if you move outside of its service area, lose Medicare or Medicaid eligibility, join a drug plan, or if the plan's contract with Medicare ends.
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Supplemental coverage
Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Most people get Part A for free, but some have to pay a premium for this coverage. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. Medicare Part A coverage begins the month the individual turns 65, provided they file an application within 6 months of their 65th birthday.
Once you’ve signed up for Part A and Part B, you can choose how to get your health coverage. There are two main ways to get your Medicare coverage: Original Medicare and Medicare Advantage. With Original Medicare, you pay for services as you get them. When you receive a covered service, Medicare pays part of the cost and you pay your share.
- Medicare Supplement Insurance (Medigap): This is extra insurance you can buy from a private company to help pay your share of costs in Original Medicare. Generally, you need Part A and Part B to buy a Medigap policy. Some Medigap policies offer coverage when you travel outside the U.S. Medigap policies do not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs. If you’re under 65, you might not be able to buy a Medigap policy, or you may have to pay more.
- Coverage from a former employer or union: You may already have other coverage, like employer or union benefits. You can learn how Medicare works with other insurance and get free personalized health insurance counseling by contacting your local State Health Insurance Assistance Program (SHIP).
- Medicaid: This is a federal and state program that provides health coverage for low-income individuals and families.
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Frequently asked questions
Original Medicare is federal health insurance for anyone aged 65 and older, as well as some people under 65 with certain disabilities or conditions. It includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Original Medicare covers inpatient hospital care, doctors' services and tests, and preventive services. It does not cover long-term care, dentures, routine physical exams, and in most cases, dental services.
If you are receiving monthly Social Security or RRB benefits, you will automatically be enrolled in Medicare Part A when you turn 65. If you are not receiving these benefits, you must file an application for Medicare by contacting the Social Security Administration.
Yes, you can have both Original Medicare and other insurance, such as employer or union coverage, or Medicaid. Original Medicare covers most, but not all, of the costs for approved health care services and supplies, so having additional insurance can help pay your share of costs.
