Original Medicare (Parts A & B)

 Original Medicare is the foundational health insurance program offered by the federal government to help cover healthcare costs for eligible individuals, primarily those aged 65 and older. It consists of Part A and Part B, each providing essential coverage for different types of healthcare services.

Medicare Part A, also known as Hospital Insurance, helps cover the costs associated with inpatient care. This includes:

• Hospital Stays: Coverage for room, meals, and general nursing during inpatient stays.
• Skilled Nursing Facility (SNF) Care: Coverage for rehabilitation and skilled nursing care after a hospital stay, when medically necessary.
• Home Health Care: Limited coverage for home health services, such as physical therapy, after a hospital stay.
• Hospice Care: Coverage for hospice care services for those with a terminal illness, aimed at making them as comfortable as possible.

Most people don’t pay a monthly premium for Part A if they or their spouse have paid Medicare taxes while working. However, deductibles and coinsurance apply, depending on the services received.

Medicare Part B, often referred to as Medical Insurance, covers outpatient care and other essential medical services. This includes:

• Doctor Visits: Coverage for services like routine check-ups, specialist consultations, and preventive screenings.
• Preventive Services: Includes annual wellness visits, flu shots, diabetes screenings, and other preventive services to help maintain good health.
• Durable Medical Equipment (DME): Coverage for medically necessary equipment like wheelchairs, walkers, and oxygen.
• Outpatient Services: Services such as outpatient surgery, lab tests, mental health services, and more.

Unlike Part A, Medicare Part B requires a monthly premium. The premium amount may vary depending on your income, and there are deductibles and coinsurance for most services. Typically, Medicare Part B pays 80% of approved services, leaving you responsible for the remaining 20%.

• Nationwide Coverage: Original Medicare allows you to see any doctor or specialist in the United States who accepts Medicare, without the restrictions of network requirements.
• Out-of-Pocket Costs: Although Original Medicare provides significant coverage, it doesn’t cover all expenses. You’ll need to pay for deductibles, copayments, and coinsurance.
• No Prescription Drug Coverage: Original Medicare (Parts A & B) does not include prescription drug coverage. To cover prescription costs, you’ll need to enroll in a separate Medicare Part D plan.

While Original Medicare offers broad coverage, there are certain services and costs it doesn’t cover, such as:

• Long-term Care: Routine custodial care or nursing home stays that aren't related to recovery from illness or injury.
• Vision and Dental: Routine dental care, eye exams for glasses, and hearing aids are not covered.
• Overseas Medical Care: Medicare generally does not cover medical care outside of the United States.

To help with the gaps in Original Medicare coverage, many individuals choose to purchase a Medicare Supplement (Medigap) policy. Medigap helps cover out-of-pocket expenses like deductibles, coinsurance, and copayments, providing additional peace of mind.

You are eligible for Original Medicare if:

• You are 65 years or older.
• You are under 65 and have a qualifying disability.
• You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease).

Most people enroll in Original Medicare during their Initial Enrollment Period (IEP), which begins three months before your 65th birthday and ends three months after.

Enrolling in Original Medicare is simple and usually occurs automatically if you are already receiving Social Security benefits at age 65. For those who need to manually enroll or want guidance on their options, our team is here to assist you. We can help you navigate the enrollment process and ensure you’re making the best decision for your health coverage needs.

Original Medicare (Parts A & B) is the starting point for healthcare coverage in retirement, providing essential protection for hospital and outpatient services. Understanding the scope of what it covers—and what it does not—is crucial in ensuring you have the right level of coverage to protect your health and your finances.

If you need help understanding your options or deciding what supplemental coverage might be best for you, contact us today. Our experienced team at The Medicare Firm is dedicated to providing advocacy and support to ensure you get the best possible coverage for your needs. We are a health insurance provider dedicated to providing high-quality and affordable health insurance plans to individuals and families. Our plans are designed to meet the unique needs of each of our clients and provide comprehensive coverage for all of their healthcare needs.