Original Medicare is a health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). It is a federal program that is administered by the Centers for Medicare and Medicaid Services (CMS).
Original Medicare has two parts: Part A and Part B. Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Part B covers medically necessary doctor’s services, outpatient care, and some preventive services.
You can get Original Medicare if you are:
- 65 or older
- Under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months
- Under 65 and have End-Stage Renal Disease (ESRD)
If you are eligible for Original Medicare, you will automatically be enrolled in Part A. You will need to enroll in Part B if you want it. You can enroll in Part B during your Initial Enrollment Period, which is the 7-month period that starts 3 months before you turn 65 and ends 3 months after you turn 65. If you miss your Initial Enrollment Period, you may be able to enroll during a Special Enrollment Period.
Medicare Part A is funded by payroll taxes. If you have worked and paid Medicare taxes for at least 10 years, you will not have to pay a monthly premium for Part A. If you have not worked and paid Medicare taxes for at least 10 years, you will have to pay a monthly premium for Part A.
Medicare Part B is funded by monthly premiums, which are deducted from your Social Security check. You also pay a Part B deductible and coinsurance for covered services.
Here are some things that Original Medicare covers:
- Inpatient hospital care: This includes care in a hospital, critical access hospital, or skilled nursing facility.
- Skilled nursing facility care: This includes care in a skilled nursing facility after you’ve been in a hospital for at least three days.
- Hospice care: This is care for people who are terminally ill and have less than six months to live.
- Some home health care: This includes care that you need at home after you’ve been in a hospital or skilled nursing facility.
- Medically necessary doctor’s services: This includes services that your doctor thinks are necessary to treat your medical condition.
- Outpatient care: This includes care that you get at a doctor’s office, clinic, or hospital outpatient department.
- Some preventive services: These include services that are designed to keep you healthy, such as annual physical exams and vaccinations.
Here are some things that Original Medicare doesn’t cover:
- Most prescription drugs: This includes prescription drugs that you take at home.
- Dental care: This includes routine dental care, such as cleanings and checkups.
- Vision care: This includes routine vision care, such as eye exams and glasses.
- Hearing aids: This includes hearing aids and hearing aid exams.
- Custodial care: This is care that is not medically necessary, such as help with bathing, dressing, and eating.
- Private-duty nursing: This is care that is provided by a nurse who is not employed by a hospital or nursing home.
- Ambulance services: This includes services that are not medically necessary, such as transportation to and from a doctor’s office.
If you need coverage for these services, you may want to consider getting a Medicare Advantage plan or a Medigap plan. Medicare Advantage plans are private health insurance plans that are designed to provide all the coverage of Original Medicare, plus additional benefits. Medigap plans are private health insurance plans that are designed to fill in the gaps in Original Medicare coverage.
If you’re not sure what coverage you need, you can talk to a Medicare counselor or your local Social Security office. They can help you understand your options and choose the plan that’s best for you.
Here are some tips for getting the most out of Original Medicare:
- Enroll in Part A and Part B if you are eligible.
- Choose a Medicare Advantage plan or Medigap plan if you need coverage for services that Original Medicare doesn’t cover.
- Compare plans carefully before you enroll.
- Read your plan documents carefully so you know what is and isn’t covered.
- Keep track of your medical expenses so you can file claims and get reimbursed.
- Get help if you need it. There are many resources available to help you understand and use Medicare.