Medicare FAQ: Original MedicareAugust 26th, 2013 | Posted by in Medicare Costs | Medicare Coverage | Medicare Eligibility | Medicare Plans
Original Medicare is health coverage offered by the federal government to Americans who are older or those with certain disabilities. In the fourth post of our Frequently Asked Questions (FAQ) series, we will focus on explaining Original Medicare, Part A and Part B.
In 2013, around 50 million American citizens and permanent residents were enrolled in the Medicare insurance program. Medicare is a national health insurance program that is offered to eligible individuals age 65 and older, or those under 65 with certain disabilities or illnesses. These eligible seniors and disabled individuals have the option to sign up for Original Medicare coverage. In this post, we will answer some questions about coverage, costs, and benefits associated with Original Medicare.
What is Original Medicare?
Original Medicare is the traditional fee-for-service coverage managed by the federal government. This means that there is generally a cost of each health service provided. It is important for you to see a doctor, health care provider, and/or hospital that accept Medicare in order for these services to be covered. You will commonly hear Original Medicare be referred to as Part A and Part B.
What is Medicare Part A?
Medicare Part A is one part of Original Medicare coverage. Also referred to as hospital insurance, it covers medically necessary services that are primarily provided in hospitals, nursing homes, hospices, and skilled nursing facilities. This includes, but is not limited to, inpatient hospital care, home health services, and hospice care.
What is Medicare Part B?
Medicare Part B is the other part of Original Medicare coverage. Also referred to as medical insurance, it covers medically necessary health and preventative services not already covered by Part A. This includes hospital transportation, durable medical equipment, mental health services, certain vaccinations, and yearly “wellness” visits.
For more information on what Medicare Part A and Part B cover, please refer to our previous FAQ post on Medicare coverage.
Who is eligible for Original Medicare?
In most cases, you will automatically get Original Medicare when you first become eligible. This applies to individuals who:
- Already get retirement benefits from Social Security or the RRB, with the exception of Puerto Rico where only Part A enrollment is automatic
- Have collected disability benefits for two or more years
- Have ALS, also known as Lou Gehrig’s Disease
For individuals who are automatically enrolled, they will get a red, white, and blue Medicare card in the mail three months before the month they become eligible, which may be their 65th birthday or their 24th month of receiving disability benefits. Beneficiaries have the option to drop Part B if they choose to do so.
Individuals who are not automatically enrolled and will need to sign up for Part A and B may include those who are:
- Not receiving retirement benefits as they may still be working
- Have End-Stage Renal Disease (ESRD)
- Live in Puerto Rico and want to enroll in Part B
These individuals will want to enroll during their seven month Initial Enrollment Period (IEP), which starts three months before they become Medicare eligible and lasts for three months afterwards. If they do not sign up during their IEP, they can sign up during the General Enrollment Period. This enrollment period lasts from January 1 and March 31 of each year with coverage starting on July 1. However, this means that you will have to pay a higher monthly premium for late enrollment. The length of these late enrollment penalties will depend on how long you could have enrolled in Part A and/or Part B coverage and did not.
How do I apply for Original Medicare?
If you are not automatically enrolled in Part A and Part B, you can do so using one of the following methods:
- Apply online at the Social Security website.
- Apply in person by visiting your local Social Security office.
- Apply online by calling Social Security at 1-800-771-1213 or, if you worked for a railroad, call the RRB at 1-877-772-5772.
How much does Original Medicare cost?
Most beneficiaries get Part A coverage without needing to pay a monthly premium if they or their spouse paid Medicare taxes for 10 or more years. Part B coverage does come with a monthly premium, which depends on when you first signed up for coverage and may increase if you fall within a higher income and asset bracket.
You are generally responsible for a set amount, also known as a deductible, before Medicare pays its share. For each eligible service, the government pays the health care provider directly for their portion of the costs of health services you receive. Additionally, you may be responsible for a coinsurance or copayment for certain covered services and supplies.
Please note that there is no limit on how much you pay out of your own pocket, so it may be in your best interest to consider enrolling in a private health insurance plan. These plans, which include Medicare Advantage, Part D, and Supplement (Medigap) plans, may provide you with additional coverage on costs that Original Medicare does not cover and help reduce your out-of-pocket costs. To learn more about how to enroll in these plans, please visit our previous FAQ post on Medicare enrollment.
Do you have other questions about Original Medicare? Ask us in the comments below.
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