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Original Medicare
Original Medicare is the federal health insurance program primarily available to individuals age 65 and older, as well as certain younger people with disabilities. It consists of Part A (Hospital Insurance) and Part B (Medical Insurance).
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Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice services, and some home health care.
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Part B helps pay for doctor visits, outpatient services, preventive care, medical equipment, and other medically necessary treatments.
With Original Medicare, beneficiaries can generally see any doctor, hospital, or healthcare provider in the United States that accepts Medicare, offering broad access to care without network restrictions. Medicare typically pays a large portion of covered medical costs, but beneficiaries are responsible for deductibles, coinsurance, and other out-of-pocket expenses unless they have additional coverage such as a Medicare Supplement plan, Advantage Plan or MSA.
Who qualifies for Medicare
You're qualified for Original Medicare (Part A & B) if:
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you're 65 or older
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If you are under 65, you may qualify if you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months.
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Individuals with End-Stage Renal Disease (ESRD), which involves permanent kidney failure requiring dialysis or a transplant, are also eligible regardless of age.
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people diagnosed with Amyotrophic Lateral Sclerosis (ALS) qualify immediately upon diagnosis.
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You must also be a U.S. citizen or legal resident who has lived in the U.S. for at least five years.
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What are the costs of Medicare
Medicare Part A:
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Most people do not pay a monthly premium for Medicare Part A because they or their spouse paid Medicare taxes while working. If you or your spouse worked and paid Medicare taxes for at least 40 quarters (about 10 years), you generally qualify for premium-free Part A.
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If you do not meet the work requirement, you may still enroll in Part A but will need to pay a monthly premium, which is based on how long Medicare taxes were paid. Individuals who worked 30–39 quarters typically pay a reduced monthly premium, while those who worked fewer than 30 quarters pay the full Part A premium. Even when Part A is premium-free, beneficiaries may still have deductibles and cost-sharing for hospital and inpatient services.
Medicare Part B:
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Most people enrolled in Medicare Part B pay a monthly premium, which is set each year by Medicare. The standard Part B premium is paid by most beneficiaries, but the exact amount can vary depending on income. Individuals with higher incomes may pay an additional amount called the Income-Related Monthly Adjustment Amount (IRMAA), which increases the monthly premium based on reported income from previous tax returns.
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The Part B premium is typically deducted directly from Social Security benefits, although it can also be paid separately if someone is not yet receiving Social Security. In addition to the monthly premium, Part B also has an annual deductible, and after the deductible is met, Medicare generally pays about 80% of approved medical costs, leaving the beneficiary responsible for the remaining 20% unless they have additional coverage such as a Medicare Supplement, Advantage Plan or MSA.
When can I enroll in Medicare Part A & B
Initial Enrollment Period (IEP) Part A & B
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If you plan to enroll at 65, your initial Enrollment Period (IEP) begins three months before, and ends three months after, your 65th birth month. Coverage can begin as soon as the first day of the month you turn 65.
Annual Enrollment Period (AEP) Oct 15 - Dec 7
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During this time you can apply for any type of Medicare plan - Part A, B, C (Medicare Advantage), D (Prescription Drug) and Medigap. It is also the time when you can freely move between plan types.
Open Enrollment Period (OEP) Jan 1 - Mar 31
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This period is limited to those enrolled in a Medicare Advantage Plan. During this time you can switch from your current Medicare Advantage plan to another Medicare Advantage plan (with or without drug coverage) or to Original Medicare (with or without a Part D drug plan)
Special Enrollment Period (SEP)
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Certain events may qualify you for a change in your Medicare coverage, such as leaving your plan service area, changes to your financial eligibility or losing employer coverage.
General Enrollment Period (GEP) Jan 1 - Mar 31
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The General Enrollment Period (GEP) is the time period every year when a beneficiary may enroll in Medicare for the first time if they missed their Initial Enrollment Period (IEP) and do not qualify for the Special Enrollment Period (SEP). Your coverage starts the month after you sign up. You might pay a monthly late enrollment penalty.
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