Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). has two parts: Medicare Part AMedicare Part A, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility or other inpatient services. Medicare Part A is part of Original Medicare. and Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive..
Part A and Part B provide hospital and medical coverage for individuals 65 years of age and older.
Medicare customers can see any doctor in the country that accepts Medicare.
You have a seven-month window when you turn 65 called your Initial Enrollment Period (IEP)The Initial Enrollment Period (IEP) is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. to enroll in Original Medicare–the month of your birthday plus three months before and after your birthday month. If you miss your IEP, you’ll need to wait for the annual General Enrollment Period.
With more than 60 million Medicare enrollees in the country, you, or someone you know, receive Medicare benefits. If you or a loved one will soon be eligibleSome health plans require you to meet minimum requirements before you can enroll. for Medicare, and have questions, we have answers.
Medicare: The Basics
Medicare is public health insurance for Americans that:
- are 65 years of age or older.
- are younger than 65 years of age but have qualifying disabilitiesA disability is a restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being. The Social Security Administration judges disability — and whether you qualify for financial assistance — based on whether you can work..
The Medicare insurance program is run by The Centers for Medicare & Medicaid Services (CMS). The program is funded partially by the federal budget, income taxes paid to Social Security and Medicare, and premiums paid by Medicare beneficiaries. Original Medicare (Part A and Part B) insurance can be used at any doctor or hospital in the U.S. that accepts it.
The most popular form of Medicare is Original Medicare, which is Parts A and B only. That’s why it’s the best place to start.
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Medicare Part A and Medicare Part B cover most standard medical services. Part A and Part B cover facility costs and Medicare-approved services you receive inside. You may hear Part A called “hospital insurance,” and Part B called “medical insurance.”
Part A Hospital Insurance
- Skilled nursing facility care
- Hospice Care
- Home health care
Part B Medical Insurance
- Doctors & other care providers
- Outpatient Care
- Home health care
- Medical equipment (like walkers, wheelchairs, or beds)
- Preventive & screening services
Between Parts A and B, Original Medicare covers a wide range of services. For a deeper look into what you can expect from your Medicare policy, check out our information on Original Medicare Parts A and B coverage. GoHealth can also help you with options like Medicare Supplement Insurance (Medigap) and Medicare Advantage.
For most people, their budget is front and center when considering which health insurance to choose. Here’s a starting point when working out your budget:
Medicare Part A costs for 2022
- Deductible: $1,556
- Premium: $0 (for most people)
Keep in mind:
- You’ll want to know if you’re responsible for paying a premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.. Most individuals don’t have a Part A premium, but it can vary from person to person based on employment and tax history.
- You’ll be responsible for your Part A deductibleA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself..
Medicare Part B costs for 2022
- Deductible: $233
- Premium: $170.10
Keep in mind:
- Medicare Part B has a standard yearly deductible cost.
- Medicare Part B has a standard monthly premium cost.
The standard premium for Medicare Part B is income-based. For both Part A and Part B, after you meet your deductible, your cost for care will be approximately 20%, and Medicare will pay about 80% for the remainder of your benefit calendar year.
There are plenty of other factors to consider, including copaymentsA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment., coinsurance, and when to enroll. Learn more about what goes into Original Medicare costs.
Are you eligible for cost-saving Medicare subsidies?
You know what’s included in Original Medicare and what it covers. How do you enroll in Original Medicare? Most Americans are automatically enrolled in Part A when they reach 65 years of age. You must contact the Social Security Administration to enroll in Part B if you’re already enrolled in Part A. You can enroll online if you actively sign up for both Parts A and B at the same time. Because you pay a premium for Part B coverage, you can turn down the coverage. If you turn down Part B coverage but choose to enroll later, you may have to pay a higher monthly premium.
Understanding that you will need to add Medicare Prescription Drug Plan (Part D) coverage is essential. Medicare Prescription Drug coverage (Part D) is added to Original Medicare. What does that mean? Here are two important details to help explain:
- Part D is an optional Medicare benefit. It’s recommended if you think you’ll need prescription medication in the future or currently depend on prescriptions to manage your health.
- Private health insurance companies administer Part D. The federal government sets specific requirements, but private health insurance companies decide which drugs to cover.
To join Part D, you can choose a Prescription Drug Plan (PDP) or a Medicare Advantage plan that includes drug coverage (MA-PD). You can add Part D coverage during any of the Medicare enrollment periods.
What extra benefits and savings do you qualify for?
The majority of Americans that choose Medicare health insurance plans are 65 years of age or older. If that’s you, you’ll want to remember the seven-month rule, which says that you have seven months to enroll in Medicare during the year you turn 65.
For example, if you turn 65 in August:
- Three months before your birth month: May, June, July
- Your birth month: August
- Three months after your birth month: September, October, November
For some people with specific disabilities and illnesses, Medicare is available before they reach 65 years of age. If you’re an American citizen, or have lived in the U.S. legally for five or more years, you’re eligible for Medicare if any of the following apply to you:
- You’re 65 years of age or older.
- You’ve received Social Security disability benefits for more than 24 consecutive months.
- You’ve received disability benefits from the Railroad Retirement Board for more than 24 consecutive months.
- You have kidney failure, also known as end-stage renal disease, requiring permanent dialysis or need a kidney transplant.
- You’re living with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Here’s a recap of Original Medicare, its costs, how to enroll, and what it covers:
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- If you want prescription drug coverage, you can join a separate Part D plan with a private health insurance provider.
- To help pay your out-of-pocket costs in Original Medicare (like 20% coinsurance), you can also explore supplemental coverage.
- You can use any doctor or hospital that accepts Medicare, anywhere in the U.S.
Original Medicare is one way to get Medicare. The other way is Medicare Advantage. We recommend you also take time to learn about Medicare Advantage, Medigap, and out-of-pocket costs. These are all important pieces of making the best decision for your care. You can always contact a GoHealth licensed insurance agent to get answers. GoHealth works for you, not insurance companies, and will take time to discuss all your options.
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You can enroll in Medicare over the phone, in person, or online. If you have questions about Medicare policies, a partner like GoHealth can help you get started. It’s important to note that your initial enrollment window spans seven months, starting three months before the month of your 65 birthday and the three months that follow your birthday month. For example, if you turn 65 on May 1, you are eligible to enroll:
- February to April
- And, June to August
To enroll, you will need some basic information:
- Name, address, phone number
- Social Security number
- Identification documents, such as a birth certificate, driver’s license, or proof of U.S. citizenship.
If you’re working at age 65 and you have health coverage from your employer, then you don’t need to enroll in Medicare. You’ll be eligible for a special enrollment period if you lose your coverage.
If your company has less than 20 employees receiving health insurance, then you should enroll in Medicare as your primary insurance. Your employer can pay less or nothing for your care in this instance. It is important to know that enrolling in Medicare Part A when you turn 65 won’t cost you anything. It may not be a bad idea to enroll on time at 65.
Medicare open enrollment occurs each fall, from October 15 to December 7. At this time, you can switch from Original Medicare to Medicare Advantage. If you drop Medicare Advantage and switch to Original Medicare, you can sign up for Part D during the open enrollment period.
Between January 1 and March 31 each year, anyone with a Medicare Advantage plan can elect to leave and return to Original Medicare, or you can switch to a different Medicare Advantage plan.
There may be special enrollment rights available during the year. If you’re unsure of how to maximize your plan or enrollment periods throughout the year, contact us to discuss how we can partner to help you get the right plan.
You can spend the money you’ve already deposited in your HSA prior to turning 65. You can use any saved HSA funds on Medicare Part B and Part D expenses. If you contribute to a Health Savings Account (HSA)A Health Savings Account (HSA) can pay for healthcare expenses. Your pre-tax income is deposited into your HSA to pay for medical expenses., you should know that you are not allowed to contribute to an HSA once you turn 65.