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How does Original Medicare work?
Original Medicare is a federal health care program made up of both Medicare Part A (hospital insurance) and Part B (medical insurance). It’s a fee-for-service plan, which means you can go to any doctor, hospital, or other facility that’s enrolled in and accepts Medicare, and is taking new patients.
Medicare was set up to help people 65 and older. In 1972, Medicare became available to people with disabilities and End-Stage Renal Disease/kidney failure.
What does Medicare Part A and Part B cover?
You can enroll in Part A once you turn 65. If you're already collecting Social Security disability benefits, you'll be automatically enrolled in Part A.
Medicare pays 80 percent of approved charges and you pay about 20 percent.
Part B is optional because you have to pay a monthly premium and meet a deductible before Medicare will pay benefits.
What does Medicare Part A and B not cover?
Medicare Part A and Part B does not cover:
- Long-term care (i.e. nursing homes)
- Most dental care (i.e. dentures)
- Eye exams for prescription glasses
- Cosmetic surgery
- Hearing exams and hearing aids
- Routine foot care
- Health care outside of the US
What’s the difference between Medicare Part A and Medicare Part B?
Part A is the hospital services part of Medicare. This benefit covers inpatient care, hospital stays, skilled nursing facility care, hospice care, and medically needed home health care services.
Part B is the medical services part of Medicare. It covers many of the medically necessary services not covered in Part A, such as outpatient and preventive services. This involves things like x-rays, bloodwork, doctor’s visits, and outpatient care. It will also cover other medical items such as diabetic test strips, nebulizers, and wheelchairs.
Do Medicare Part A and Part B cover prescription drugs?
Original Medicare (Part A and Part B) only covers prescriptions in a couple of instances. This can be medications you get as part of inpatient hospital care, as well as injections and infusions you may get in a doctor’s office.
You’ll need to enroll in a Medicare Part D Prescription Drug Plan to be covered for outpatient prescription medications.
What do Medicare Part A and B cost?
With both Medicare Part A and B, you have to pay annual deductibles, coinsurance, and copays. For certain medical procedures, you may have additional out-of-pocket costs to pay. You can buy a Medicare Supplement Insurance plan (Medigap), which can help pay some of these costs.
What does Part A cost?
With Medicare Part A, you may have to pay copays and deductibles for hospital stays, but may not have to pay a monthly premium. Copays and deductibles apply to hospital benefit periods, which start when you enter a hospital or skilled nursing facility, and end 60 days after you’ve left the facility (as long as you have not received skilled care in any other facility during those 60 days). It’s important to note that:
- For each hospital benefit period, you pay a deductible.
- You pay a copay if you’ve stayed in a hospital for more than 60 days.
- There’s no deductible or copayment for home health care or hospice care.
For many people, Part A comes without a monthly premium. You may have no monthly premium if you paid a certain amount toward Medicare taxes while working. In this case, you are often automatically enrolled in premium-free Part A.
If you don’t automatically get premium-free Part A, you may be able to buy it if you (or your spouse/partner):
- Are age 65 or older and allowed to (or are enrolling in) Part B to meet the citizenship and residency requirements.
- Are under age 65 and are disabled but no longer get premium-free Part A because you returned to work.
What does Part B cost?
With Medicare Part B, you pay a standard monthly premium that’s based on your income. In some cases, your monthly premium may be higher if you didn’t sign up for Part B when you became eligible.
You may also need to meet an annual deductible before Medicare kicks in and starts paying. Once you’ve met your deductible, you will pay a 20 percent copay for approved Medicare Part B services.
You can always buy a Medicare Supplement Plan that pays your Part B deductible, as well as other out-of-pocket costs such as copays and coinsurance.
How do you enroll in Original Medicare?
To enroll in Original Medicare (Part A and Part B), you must be 65 and don’t necessarily have to be retired. Initial enrollment period packages are sent to people 3 months before they turn 65 or during their 25th month of disability benefits.
If you’ve received Social Security disability benefits for 24 months, you are automatically enrolled in Part A and Part B.
Need help paying for Medicare?
Medicare gives financial aid for people who have limited income and support. If you feel you may qualify, you can learn about eligibility requirements by either: