Original Medicare

Original Medicare Insurance

Medicare is a federal health insurance program. Original Medicare eligibility begins with an individual aging in (turning 65), or after 24 months on disability (regardless of age) for a qualifying ailment. Original Medicare has four separate parts; A, B, C, and D. Part A will be the hospital coverage. Part B will be the doctors’ coverage. Part C is Medicare Advantage, or “Managed Care” (i.e. HMOs, PPOs, PFFS, and SNP). Part D is your Rx coverage, or Prescription Drug Plans (PDP). Some of these parts work together, some do not. Be sure to understand which plans/parts work together, and which ones do not.

Original Medicare Part A

Part A, Hospital Coverage, is generally offered at no additional cost to qualifying individuals who have at least forty calendar quarters, ten years, of employment in any job in which Social Security taxes were paid for in the United States. You are eligible if you qualify for Railroad Retirement benefits. Lastly, if you were a federal employee after Dec. 31, 1982, or a state or local employee after Mar. 31, 1986 you will qualify for free Part A. The cost for Part A otherwise could cost you over $400 per month. Part A (Hospital) covers most medically necessary hospital, skilled nursing facility, hospice care, and home health. Part A is not full coverage. It will have a reoccurring deductible and other out of pocket expenses.

Original Medicare Part B

Part B, Doctors and Outpatient services, is optional coverage that requires a premium to be paid monthly. The premium will be based on, up to, the previous two years of annual income. (See Income Chart) Medicare Part B covers most medically necessary doctors’ services, hospital out-patient services, durable medical equipment, preventive care, lab test, x-rays, mental health care, and some ambulance charges. Part B is not full coverage. There is still a deductible to be met and other out of pocket expenses.

Original Medicare Part C

Part C, or Medicare Advantage, is the part of Medicare that allows private health insurance companies to provide one Medicare benefits. Medicare private health plans are known as HMOs, PPOs, PFFS, and SNP. You can choose to get your Medicare coverage through a Medicare Advantage plan instead of Original Medicare, but you cannot have both. You cannot have Medicare Parts A and B with Part C. Medicare Advantage plans must offer at least the same benefits as Original Medicare (Parts A and B) but can do so with different costs, rules and coverage restrictions. It is possible to get Part D as part of the benefits package if you choose. There are many choices of Medicare Advantage plans that are available, which are identified by an approved area Network. It is possible to pay a monthly premium for this coverage, in addition to your Part B premium. Enrollment outside of your Open Enrollment is typically between Oct. 15th through Dec. 7th of each year, or Annual Enrollment Period (AEP).

Original Medicare Part D

Part D, or Medicare Prescription Drug Plans (PDPs), is the part of Medicare that provides prescription drug coverage. Part D is provided only through private insurance companies that have legal agreements with the government; it is never provided directly from the government. If you want Part D, you must choose Part D coverage that works with your Medicare health benefits. If you have Original Medicare, choose a stand-alone Part D plan. Enrollment outside of your Open Enrollment is typically between Oct. 15th through Dec. 7th of each year, or Annual Enrollment Period (AEP). If a Part D plan is not picked up when eligible you will be penalized 1% each month you could have had the plan, and didn’t. This penalty will be paid separately to Medicare if you enroll in a Part D plan in the future. There are three phases of coverage to understand with this type of coverage. The three phases are the Initial Coverage, Donut-Hole, and Catastrophic. It is important to understand these phases, particularly if you find yourself requiring high cost for your prescribed medication.

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