Original Medicare is a federal health insurance program. The Federal Medicare program is for individuals 65+ years old, those under 65 with specific disabilities, and those diagnosed with End-Stage Renal Disease and Lou Gehrig’s disease.
Medicare parts explained
Medicare has four parts: Part A, Part B, Part C, and Part D. Original Medicare is often used interchangeably with traditional Medicare and refers to Medicare Parts A and B only. Medicare is health insurance that the federal government manages. Each part of Medicare comes with a monthly premium.
Part A is your inpatient coverage or coverage for any hospital visits. You’re eligible for premium-free Part A if you paid into Medicare for at least 40 quarters.
Part B is your outpatient coverage or coverage for any doctor visits. Part B comes with a standard monthly premium. If you fall into a higher income bracket, you could pay more.
Medicare Part C & Medicare Part D
Part D is your prescription drug coverage. Part B & Part D come with late enrollment penalties if you don’t enroll when you’re first eligible and don’t have another form of creditable coverage.
Medicare Part C works differently than the rest of the parts of Medicare. It’s managed through a private carrier instead of the government.
Eligibility for Original Medicare
You’re eligible for Original Medicare once you turn 65 years old. You’re also eligible if you’ve been collecting Social Security Disability Income for at least 24 months or you’ve been diagnosed with ESRD or Lou Gehrig’s disease.
Original Medicare coverage
Hospital insurance, or Medicare Part A, covers inpatient hospital stays, skilled nursing facility care, and specific home health care.
Your medical insurance, or Medicare Part B, covers doctor visits, outpatient care, durable medical equipment, and preventive services.
Part D is your prescription drug coverage and covers most vaccines.
Part C is Medicare Advantage. When you have a Part C Medicare Advantage plan, the private carrier pays instead of Medicare.
Gaps in the Orignal Medicare coverage
Medicare does come with many coverage gaps. These gaps include deductibles, coinsurance, and copays.
Medicare, as of now, does not include coverage for dental, hearing, or vision. Additionally, Part B only covers 80% of medical services in an outpatient facility.
The good news is that there are supplemental Medicare plans available. You can either enroll in a Medicare Advantage plan or a Medicare Supplement plan.
It’s important to know that both work very differently. Medicare is broken down into parts, and Medigap is broken down into plans.
FAQs
When are you eligible for Medicare?
Upon turning 65, you become eligible for Medicare. If you are diagnosed with specific health conditions, such as ALS, or ESRD, you may begin before your 65th birthday. Likewise, if you’ve been on disability for more than 24 months, you may qualify for Medicare before the age of 65 as well
What does Original Medicare include?
Original Medicare is technically only Part A & Part B, which the federal government standardizes. Part C & Part D is administered through private insurance carriers.
Medicare Part A covers inpatient and hospice services and Medicare Part B covers outpatient services and durable medical equipment.
How to Switch Back to Original Medicare?
If you left Original Medicare & enrolled in a Medicare Advantage plan, you can switch back to Original Medicare during the Annual Enrollment Period.
If you had a change in circumstance, you might qualify for a Special Enrollment Period. This SEP will allow you to leave your Medicare Advantage plan and switch back to Original Medicare.
What documentation is required for Medicare in the United States?
You’ll need these documents when applying for Medicare:
- Document proving your age, such as a birth certificate, census record, or vaccine record
- Your Social Security card
- Proof of legal residency
- Military service papers (if military service was before 1968)
How to get help with your Original Medicare coverage
If you’re enrolled in Medicare Part A and Part B and need to fill in the gaps in coverage, call us. Our agents will see what supplemental Medicare plans are available in your area. These supplemental Medicare plans will give you peace of mind about your Medicare coverage. You can also use our online rate form to see plans in your area now.
