What Is Original Medicare?

Original Medicare is a health insurance program managed by the federal government. It provides coverage for individuals aged 65 and older, certain younger people with disabilities, and individuals with specific conditions such as end-stage renal disease.

Original Medicare is divided into two parts: Part A and Part B.

• Part A (Hospital Insurance): This part covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Part B (Medical Insurance): Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services such as routine check-ups, vaccines, diagnostic screenings, and mental health counseling.

Who Is Eligible For Original Medicare?

Eligibility for Original Medicare generally extends to the following groups:

• Individuals aged 65 or older: Most people become eligible for Medicare when they turn 65, regardless of their health status or income level.
• Certain younger individuals with disabilities: People under 65 may be eligible for Medicare if they have a disability and have received Social Security Disability Insurance for over two years.
• Individuals with End-Stage Renal Disease (ESRD): ESRD is a condition characterized by permanent kidney failure requiring dialysis or a kidney transplant. People with ESRD of any age are eligible for Medicare.
• Individuals with Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, individuals with this condition become eligible for Medicare when they receive disability benefits from Social Security or other government agencies.

What Are The Costs For Original Medicare?

Original Medicare isn’t a free service. It carries a cost structure akin to those seen in private insurance sector offerings, which many are likely familiar with from their employment years.

Premiums: Part A generally requires no premium payment for individuals or their spouses. On the other hand, beneficiaries must pay a premium for Part B of $164.90 in 2023. Higher-income individuals should anticipate paying a higher premium.

Deductible: Before Medicare coverage becomes active, beneficiaries must pay a predetermined sum as an out-of-pocket expense. This amount is $223 in 2023.

Copayment: Following the deductible payment, a fixed dollar amount is levied for specific services and supplies. For instance, a $20 copayment may be required.

Coinsurance: After the deductible has been met, a set percentage of the total bill for certain services is required. This typically is 20 percent of the cost for most Part B services.

What All Does Original Medicare Cover?

Original Medicare covers a wide range of medical services and supplies.

Some examples include:

• Inpatient hospital care: This includes semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
• Doctor visits: Original Medicare covers medically necessary visits to your primary care physician or specialist. These visits may include preventive services like routine check-ups, flu shots, and cancer screenings.
• Diagnostic tests: Part B covers medically necessary diagnostic tests like X-rays, blood tests, and MRIs.
• Hospice care: Medicare also covers hospice care for individuals with a terminal illness. This includes pain relief medication, nursing care, medical equipment and supplies, and counseling.
• Home health care: Medicare covers part-time skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services when prescribed by a doctor.
• Durable medical equipment: This includes items like wheelchairs, walkers, oxygen tanks, and other medically necessary equipment.
• Mental health care: Medicare also covers outpatient mental health services such as individual therapy, group:

Bottom Line

Original Medicare provides essential health coverage for millions of Americans, especially the elderly and those with disabilities. While it may not cover all medical expenses, it is a vital resource. Understanding your eligibility, costs, and coverage is important to ensure you receive the best possible care.

FAQ

Can I have other health insurance in addition to Original Medicare?

Yes, you can have other forms of insurance, such as a retiree plan or Medigap policy that provides additional coverage for services not covered by Original Medicare.

Are prescription drugs covered under Original Medicare?

No, prescription drug coverage is not included in Original Medicare. You can enroll in a separate Part D prescription drug plan or choose a Medicare Advantage plan that includes prescription drug coverage.

What happens if I don’t sign up for Original Medicare when I turn 65?

Suppose you are eligible for Original Medicare at age 65 and do not enroll during your Initial Enrollment Period. In that case, you may face a late enrollment penalty and have to pay a higher premium for Part B coverage. Understanding your eligibility and enrollment periods is essential to avoid this penalty.