What is Original Medicare?

Medicare Part A (Hospital Expense) and Medicare Part B (Medical Expense) are often referred to as Original Medicare. Original Medicare is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest.

How much does Original Medicare cost?

People usually don’t pay a monthly premium for Medicare Part A coverage if they or their spouse paid Medicare taxes while working. For Medicare Part B, most people pay a standard monthly premium. *Some people may pay a higher Medicare Part B premium based on their income

Got Questions? We Have Answers.

SPECIAL NOTE: Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time. Individuals who aren’t eligible for premium-free Medicare Part A can still enroll in Part A and pay a premium. Beneficiaries who delay enrollment after they first become eligible for Medicare Part A may be subject to a late enrollment penalty once they sign up.

MEDICARE PART B: Medicare Part B (medical insurance) is part of Original Medicare and covers medical services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition. For a full list of preventive services covered under Medicare Part B, refer to the Medicare handbook, “Medicare and You.” Beneficiaries who delay enrollment after they First Become Eligible for Medicare Part B may be subject to a Late Enrollment Penalty for as long as you have Medicare Part B. The penalty amount can go up 10% for every 12 month period you are eligible and didn’t enroll. For example, if you waited for 3 years to sign up, your penalty could be 30% of the premium.

DID YOU KNOW?

Premiums Cost NO MORE when working with an Independent Licensed Agent than going directly through the Carrier. In fact, relying on the expertise of a Licensed Professional to help you navigate the Medicare Maze can avoid costly mistakes.

What is a Medicare Advantage plan?

If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries.

A Medicare Advantage plan is required to cover everything that Original Medicare covers (except for hospice care), including emergency and urgent care. Hospice care is covered by Original Medicare, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan. But, there can be some differences between Original Medicare and a Medicare Advantage plan. Those differences can be in how much you pay out of your own pocket when you receive health care. For example, you might have lower copayments and coinsurance or a smaller deductible.

Medicare Advantage offers at least the same coverage as Original Medicare, and may offer additional benefits. It may be one way of adding coverage for routine vision, or dental services, dentures, and more. Some Medicare Advantage plans have a $0 premium.

However, Medicare Part B premium must be paid monthly in addition to your Medicare Advantage Plan Premium.

There can also be differences in the coverage you receive. Some Medicare Advantage plans include routine vision, routine dental, and/or wellness programs. Many plans also include prescription drug coverage; those plans are called Medicare Advantage Prescription Drug plans (MAPD).

Eligibility for Medicare Advantage plans

Medicare Advantage plan eligibility is based on your eligibility for Original Medicare, Part A and Part B (except if you have ESRD). Generally, if you have Medicare Part A and Part B, you are eligible for Medicare Part C. However, you must live in the service area for the Medicare Advantage plan that you’re considering.

SPECIAL NOTE: If you have other health insurance coverage, for example through an employer or union, ask your plan administrator about that plan’s rules before you enroll in a Medicare Advantage plan. In some cases, you may lose your other coverage if you enroll in the Medicare Advantage plan and you may be unable to get it back if you change your mind later.

What Is Medicare Part D?

Medicare Part D prescription drug coverage, often referred to as Part D, is provided and coordinated by Medicare-approved private insurance companies. Any beneficiary who is eligible for Original Medicare, Part A and/or Part B, and permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D. Medicare Part D coverage is optional, but if you don’t enroll in Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.

You can get Medicare Part D coverage through a stand-alone Medicare Prescription Drug Plan if you’re enrolled in Original Medicare. If you’re enrolled in a Medicare Advantage plan, you can get this coverage through a plan that includes drug benefits, also known as a Medicare Advantage Prescription Drug Plan. Different insurers offer different types of plans, so your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.

Every Medicare Prescription Drug Plan has a formulary — that is, a list of covered drugs. The formularies vary among plans. *The formulary may change at any time. You will receive notice from your plan when necessary.

Medicare Supplement Insurance Plans

Medigap help’s pay some of the healthcare costs Original Medicare doesn’t cover.

What you should know about Medigap

The Medigap policy you purchase must be clearly identified as “Medicare Supplement Insurance.” In most states, there are up to 10 different Medigap basic benefits options to choose from. Plans are labeled A, B, C, D, F, G, K, L, M, and N.

You can get a Medicare Supplement insurance plan only if you already have Original Medicare. Medigap may help pay for out-of-pocket costs under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), but it does not include benefits for Medicare Part C (Medicare Advantage plans), Medicare Part D (Prescription Drug Plans), or any other private health insurance, Medicaid, Veterans’ Administration benefits, or TRICARE.

As long as you purchase a Medigap plan during this six-month Medigap Open Enrollment Period, the insurance company CANNOT REFUSE to sell you a Medigap policy, charge you more because you have health problems, or make you wait for basic benefits to begin.

*If you apply for a Medicare Supplement insurance plan outside of your Medigap Open Enrollment Period, the private insurance company may “UNDERWRITE” the plan. That means you may be subject to a physical exam, and the insurance company CAN REFUSE to sell you the plan or they can adjust your premium based on your health status.