Learning the Basics of Medicare
Original Medicare: The Essential Foundation
Original Medicare consists of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). This is the federal health insurance program for people who are 65 or older, or younger that 65 with a qualified disability, and people with End-Stage Renal Disease (ESRD), Amyotropic Lateral Sclerosis (ALS).
What Original Medicare Covers:
Part A (Hospital Insurance): Primarily covers inpatient care in a hospital, skilled nursing facility care, hospice care, and some home health care. Most people do not pay a premium for Part A
Part B (Medical Insurance): Covers medically necessary services (like doctor visits, outpatient care, durable medical equipment) and preventive services. Most people pay a monthly premium for Part B
Understanding the Costs (The Coverage Gaps):
While Original Medicare provides essential coverage, it does not cover all of your expenses. This is why many people look into additional coverage options. (more on that later)
Deductibles: You must pay an amount out-of-pocket before Medicare begins to pay
Copayments & Coinsurance: After meeting the deductible, you typically pay a portion of the cost for covered services (e.g., 20% of the Medicare-approved amount for most Part B services)
No Out-of-Pocket Maximum: Original Medicare does not have an annual limit on what you must pay for deductibles, copayments, and coinsurance
When You Should Enroll in Original Medicare (Enrollment Basics):
Initial Enrollment Period (IEP): Your primary enrollment window starts three months before the month you turn 65 and ends three months after your birthday month—a total of seven months. Enrolling on time prevents future penalties
General Enrollment Period (GEP): If you miss your IEP and do not qualify for a Special Enrollment Period (SEP), you can enroll during the GEP, which runs from January 1st to March 31st each year. Coverage starts the month after you enroll, but you may have to pay a Part B late enrollment penalty for the rest of your life
Special Enrollment Periods (SEPs): These are windows of time available outside of the IEP or GEP, allowing you to sign up for Part B without penalty if you or your spouse were working past age 65 and covered by a group health plan. SEPs are also granted for other qualifying life events (e.g., losing existing coverage).
Automatic Enrollment: If you are already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you will typically be automatically enrolled in both Part A and Part B
Active Enrollment: If you are not collecting retirement benefits (or are disabled but Part A enrollment is not automatic), you must actively enroll during your IEP. If you or your spouse are still working and have coverage, you may be able to delay Part B without penalty (Special Enrollment Period)
Next Steps: Exploring Options
Once you are enrolled in Original Medicare, you must decide how you want to handle the costs and services that are not covered. You have a few options which are offered by private insurance companies:
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We do not offer every plan available. Currently, we represent 11 organizations which offer 613 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options. (Medicare can be reached 24 Hours a day, 7 days a week). Total Medicare plans available may vary depending on your zip code.
