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Original Medicare

Medicare Part A and Part B, often called Original Medicare, are managed by the federal government. Most individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday.

You can use any doctor, health care provider, hospital or other facility that accepts Medicare patients anywhere in the U.S. You will not need to choose a primary care doctor and, in most cases, will not need a referral to see a specialist.

Medicare Part A

Medicare Part A

Medicare Part A covers inpatient care provided in hospitals or skilled nursing facilities, home health care and hospice care for the terminally ill.

Premium

You usually don’t pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working for a specific amount of time. If you aren’t eligible for premium-free Part, you may be able to buy Part A.

Deductibles

Once you meet your Part A deductible, set annually by the federal government, it helps with your covered medical costs.

Copays

A copays may apply to specific services, such as extended stays in a hospital or skilled nursing facility. When receiving hospice care, you pay a small copay per prescription for outpatient drugs for pain and symptom management.

Coinsurance

Inpatient hospital care lasting between 61 and 90 days for each benefit period.

  • Inpatient mental health care lasting between 61 and 90 days for each benefit period.
  • Skilled nursing care lasting between 21 and 100 days of each benefit period.

Coinsurance may apply for a limited number of additional days.

Benefit periods

Part A coverage and costs are based on benefit periods. A benefit period begins the day you’re admitted to the hospital and ends when you’ve been out for 60 consecutive days. The following coverage restrictions apply to Medicare Part A:

  • Inpatient hospital care is limited to 90 days total per benefit period
  • Inpatient mental care is limited to 90 days total per benefit period
  • Skilled nursing care is limited to 100 days total per benefit period

For each type of care, you can receive coverage for 60 additional days throughout your lifetime – known as “lifetime reserve days.”

Medicare Part B

Medicare Part B

Medicare Part B covers doctor visits, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services like wellness visits, flu shots and mammograms for women.

Premium

Medicare Part B has a monthly premium that is based on when you enroll and your annual household income. Part B premiums are typically paid through Social Security withholdings. Penalties for late enrollment may apply.

Deductibles

You must first meet the annual deductible, set by the federal government, before Part B helps with your medical costs.

Copays

A copay may apply to specific services, such as those you receive in an outpatient hospital.

Coinsurance

You will pay 20% of the Medicare-approved amount for most covered services after you pay the annual deductible, with no annual out-of-pocket maximum.

After you meet your deductible for the year, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment. There is not an out-of-pocket maximum.

Considerations

Part B premiums, standard deductibles and cost share amounts generally change annually on January 1st. Under Medicare Part B, there are annual limits on services for physical therapy, occupational therapy, and speech language therapy.

Not covered by Original Medicare:

  • Dental exams, most dental care, or dentures
  • Routine eye exams, eyeglasses, or contacts
  • Hearing aids or related exams and services
  • Most care while traveling outside the United States
  • Help with bathing, dressing, eating, etc. (custodial care)
  • Most chiropractic services
  • Acupuncture
  • Routine foot care
  • Prescription drugs

Enrollment FAQs

Request more information

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