The Basics of Original Medicare
This educational resource is provided by CHL Insurance Solutions, a local independent agency. This page is intended for informational purposes only and does not constitute medical, legal, tax, financial advice, nor is it an offer of insurance or a sales solicitation.
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A Guide to Coverage and Enrollment
Navigating the transition to Medicare is a significant milestone. Understanding how the program is structured allows you to make informed decisions about your healthcare as you approach eligibility. Original Medicare is the traditional fee-for-service program managed by the federal government.
What is Original Medicare?
Original Medicare consists of two primary components: Part A (Hospital Insurance) and Part B (Medical Insurance). It is available to U.S. citizens and legal residents who have lived in the country for at least five consecutive years and are typically 65 or older. Individuals under 65 may also qualify based on specific disabilities or health conditions.
What Does Part A Cover?
Part A primarily handles inpatient care. While it does not cover all costs associated with a hospital stay, it generally assists with:
Inpatient hospital care
Skilled nursing facility care
Hospice care
Some home health care services
What Does Part B Cover?
Part B focuses on medical services and supplies that are medically necessary to treat a health condition. This includes:
Services from doctors and other healthcare providers
Outpatient care and lab tests
Durable medical equipment (like wheelchairs or walkers)
Preventive services (such as screenings and vaccines)
Understanding the Costs
Medicare is a cost-sharing program. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for a sufficient period while working. However, Part B requires a monthly premium, which is set annually by the government.
In addition to premiums, both Part A and Part B involve deductibles and coinsurance. For Part B, after the annual deductible is met, beneficiaries typically pay 20% of the Medicare-approved amount for most covered services.
Enrollment Periods
Timing is a critical factor in Medicare enrollment. There are specific windows during which you can sign up:
Initial Enrollment Period (IEP): This is a seven-month window that begins three months before the month you turn 65, includes your birth month, and continues for three months afterward.
General Enrollment Period (GEP): If you miss your IEP, you can sign up between January 1 and March 31 each year, with coverage starting the following month.
Special Enrollment Period (SEP): You may qualify for a SEP if you have a life change, such as losing employer-sponsored coverage. This allows you to enroll without a penalty for a limited time.
Late Enrollment Penalties
If you do not sign up for Part B when you are first eligible and do not have "creditable" coverage (such as from a current employer), you may face a late enrollment penalty. This penalty is added to your monthly premium for as long as you have Part B. Similarly, a penalty may apply to Part D if you go 63 days or more without creditable drug coverage.
Optional Coverage
Original Medicare does not cover everything. Many beneficiaries choose to add optional coverage to manage their out-of-pocket costs:
Medicare Supplement Insurance (Medigap): Policies sold by private companies to help pay for "gaps" in Original Medicare, like copayments and deductibles.
Part D: Standalone prescription drug plans.
Medicare Advantage (Part C): An alternative to Original Medicare that bundles Parts A, B, and usually D into a single plan managed by a private insurance company.
Deciding which combination of coverage is appropriate depends on your health needs and financial goals. For personalized guidance on which coverage option is right for you, contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Program (SHIP).
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This material is for educational purposes only and does not constitute a recommendation or endorsement of any specific coverage option. For help determining which coverage is right for you, contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Program (SHIP).
We do not offer every plan available in your area. Currently we represent 5 organizations which offer 55 products in the Gainesville, FL area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Note: Actual plan availability may vary depending on your zip code.
Non-Government Entity: CHL Insurance Solutions, LLC is a private, licensed insurance agency (FL Lic: L131407; GA Lic: 241106). We are not part of the federal Medicare program.
