All about Medicare Part A & B, or Original Medicare
Key Takeaways
Original Medicare is composed of Part A (hospital insurance) and Part B (medical insurance). Medicare beneficiaries can see any doctor in the country that accepts Medicare. You have a seven-month window when you turn 65 called your Initial Enrollment Period (IEP) to enroll in Original Medicare–the month of your birthday plus three months before your 65th birth month and three months after your 65th birth month.
What is Medicare?
Medicare is the federal health insurance program primarily for Americans age 65 and older. Signed into law in 1965, Medicare currently covers millions of people. Aimed primarily at those of retirement age, it helps make health coverage more affordable and less costly than private health insurance.
There are four different types of Medicare. Medicare Part A, also called hospital insurance, covers inpatient care; Medicare Part B, also called medical insurance, covers outpatient care. Together, they make up Original Medicare.
Medicare Part C, commonly referred to as Medicare Advantage, is an alternative to Original Medicare. Participants get many of the same benefits of traditional Medicare and may also receive additional benefits (like dental and vision, for example). Coverage is provided by private health insurers approved by the program. Medicare Part D is a prescription drug plan.
Medicare is not the same as Medicaid, a jointly funded state and federal health insurance program for vulnerable and low-income Americans in need of affordable care. Additionally, while Medicare is typically used by older people, anyone living with certain permanent disabilities may be eligible to get Medicare as well. While Medicare Part A is premium-free for most people — beneficiaries will pay deductibles and coinsurance for certain parts of this program.
What’s covered by Medicare?
Medicare Part A and Medicare Part B cover most standard medical services. Part A and Part B cover facility costs and Medicare-approved services you receive inside of those facilities. You may hear Part A called “hospital insurance,” and Part B called “medical insurance.”
Part A (Hospital Insurance)*
- Inpatient
- Hospice Care
*Medicare.gov, What Part A covers, https://www.medicare.gov/what-medicare-covers/what-part-a-covers
Part B (Medical Insurance)*
- Doctors & other care providers
- Outpatient Care
- Some home health care
*Medicare.gov, What Part B covers, https://www.medicare.gov/what-medicare-covers/what-part-b-covers
Between Parts A and B, Original Medicare covers a wide range of services. For a deeper look into what you can expect from your Medicare policy, check out our information on Original Medicare Parts A and B coverage. myHealthPolicy can also help you with options like Medicare Advantage and Prescription Drug (Part D) coverage.
How much do Medicare part A and B cost?
For most people, their budget is front and center when considering which health insurance to choose. Here’s a starting point when working out your budget:
Medicare Part A costs for 2023
Deductible: $1,600
Premium: $0 (for most people)
Keep in mind:
- It might be helpful to know if you’re responsible for paying a premium. Whether you have a Part A premium, can vary from person to person based on employment and tax history.
- You’ll be responsible for your Part A deductible.
Medicare Part B costs for 2023
Deductible: $226
Premium: $164.90
Keep in mind:
- Medicare Part B has a standard yearly deductible cost.
- Medicare Part B has a standard monthly premium cost.
The standard premium for Medicare Part B is income-based. For Part B, after you meet your deductible, your cost for care will be approximately 20%, and Medicare will pay about 80% for the remainder of your benefit calendar year.
There are plenty of other factors to consider, including copayments, co-insurance, and when to enroll. Learn more about what goes into Original Medicare costs.
How do I get Original Medicare?
If you’re 65 and getting Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Original Medicare (Parts A and B). You can expect your card in the mail three months prior to your 65th birthday.
If you’re 65 and not getting Social Security or Railroad Retirement Board benefits, you’ll need to enroll. You can start signing up when you are 64 years and 9 months old (three months before you turn 65), which is the start of your seven-month Initial Enrollment Period and ends three months after the month you turn age 65.
You can apply for Medicare three ways: 1) via online application, 2) by visiting your local Social Security office, or 3) calling Medicare at 1-800-772-1213.
You don’t need to reapply for Medicare each year. You can review and change coverage each Annual Enrollment Period which runs each year from October 15-December 7. (Medicare Open Enrollment is separate from Open Enrollment for individual marketplace plans). If you made any changes to your Medicare coverage during this time, those changes take effect on January 1.
When am I eligible to enroll in Medicare?
The majority of Americans that choose Medicare health insurance plans are age 65 or older. If that’s you, you’ll want to remember the seven-month rule, which says that you have seven months to enroll in Medicare.
For example, if you turn 65 in August:
- Three months before your birth month: May, June, July
- Your birth month: August
- Three months after your birth month: September, October, November
Younger Americans with end stage renal disease (permanent or terminal kidney failure) or Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) are also eligible for the federal program. This includes those with other qualifying disabilities who have been receiving SSDI for 24+ months.
| Type of Medicare | Coverage | Required | Cost |
|---|---|---|---|
| Medicare Part A | Hospital care | Yes | Usually no premium. Some services require deductible, copay, or coinsurance |
| Medicare Part B | Outpatient care | No, though penalties may apply to those who wait and decide to enroll later.
|
Premium, low deductible, coinsurance |
| Medicare Part C | Hospital + outpatient care and more | No | Varies by plan |
| Medicare Part D | Prescription drug plan | No | Varies by income and plan |
| Medigap |
Helps pay out-of-pocket costs for Part A and B |
No | Premium, deductibles and copays vary by plan |
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Is Medicare the right choice for you?
Here’s a recap of Original Medicare, its costs, how to enroll, and what it covers:
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- If you want prescription drug coverage, you can join a separate Part D plan with a private health insurance provider.
- To help pay your out-of-pocket costs in Original Medicare (like 20% co-insurance), you can also explore supplemental coverage.
- With Original Medicare you can use any doctor or hospital that accepts Medicare, anywhere in the U.S.
Original Medicare is one way to get Medicare. The other way is Medicare Advantage. We recommend you also take time to learn about Medicare Advantage, Medigap, and Out-of-pocket costs. These are all important pieces of making the best decision for your care. You can always contact a myHealthPolicy licensed insurance agent to get answers. Your myHealthPolicy works for you, not insurance companies, and will take time to discuss all your options.
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