Original Medicare (Parts A and B)

What do we mean by ‘Original’ Medicare?
Medicare Parts A and B, together often colloquially known as Original Medicare or Straight Medicare, are the direct government insurance most people think of when they think of Medicare. Together they provide hospitalization and medical services coverage, including doctor’s visits, screenings, emergency room care, surgery, medical supplies and equipment, home care, skilled nursing care, hospital inpatient costs and hospice care.

Who is eligible and how much does it cost?
For Parts A and B, anyone 65 and older who is entitled to Social Security is eligible (those who are disabled and have been on Social Security Disability Insurance for 24 months are also eligible). Those not eligible for Part A (meaning those individuals or spouses who have not paid into Social Security for at least 40 quarters) can buy-in to Part A (in 2015) for $224 a month (for those with 30-39 quarters) or $407 a month for those with less than 30 quarters.

Part B premiums for the upcoming year are means-tested based on your most-recently filed tax return (for 2015 premium, use your 2013 filed amounts):

2013Individual Income Limits 2013 Joint Income Limits 2015 Part B Premium
$0-85,000 $0-170,000 $104.90
$85,001-107,000 $170,001-214,000 $146.90
$107,001-160,000 $214,001-320,000 $209.80
$160,001-214,000 $320,001-428,000 $272.70
$214,001+ $428,001+ $335.70

What is covered?
For hospitalizations in 2014, Part A will pay 100% of inpatient costs for 60 days, after the deductible; 100% of skilled nursing care for 20 days after a 3-day hospital stay, and costs in excess of $152 per day for days 21-100; 100% of hospice care at home, in the hospital or nursing home for terminal patients; will pay for medically necessary home care following a 3-day minimum hospitalization or skilled nursing home stay; up to 3 pints of blood during a hospitalization or nursing home stay.

For doctor’s visits and other medical services, Part B pays 80% of approved charge for:

  • Physician fees
  • Medical equipment and supplies, including oxygen
  • Emergency room services
  • Outpatient surgery
  • Ambulance services
  • Limited podiatry and chiropractic care
  • Eyeglasses (lenses only after cataract surgery)
  • Kidney dialysis services
  • Second surgical opinions
  • Prescription drugs such as injectable cancer drugs
  • Home health care ($1810 each of physical/speech and occupational)
  • Diabetes supplies
  • Prosthetic/orthotic items
  • Smoking cessation counseling (with a smoking related illness)
  • Colorectal screenings (75%)
  • Labs and x-rays (100%)
  • Outpatient mental health services (60%)

Medicare Part B pays 100% of the cost of preventive services.

Managing Your Medicare
The Initial Enrollment Period is a special period three months prior to, the month of your 65th birthday and three months after in which a person should sign up for the various applicable Medicare services and can do so without any penalties. Most individuals will automatically be enrolled in Medicare during their Initial Enrollment Period. Medicare will mail you your Medicare card and you will receive Original Medicare (Parts A and B) by default. If you do not wish to receive Medicare, you must sign the back of your Medicare card and return it to Medicare to disenroll. If you wish to receive your Medicare coverage through a private insurer (Medicare Advantage/Part C), you must sign-up with a plan during your Initial Enrollment Period.

The General Enrollment Period runs every year from January 1 to March 31 and is the time when you can enroll in Medicare if you did not do so during your Initial Enrollment Period. Coverage will begin effective July 1 of the year of enrollment. Persons will be subject to 10% penalty for each year which they were eligible and did not sign up for Part B after the Initial Enrollment period. In order to enroll in Medicare, individuals should visit their local Social Security office (you can find yours here) or call 1-800-772-1213.

After enrolling in Medicare, you will receive your Medicare card (example) at the address Social Security has on file in approximately 30 days. Individuals should also sign up for MyMedicare.gov, an online management and record-keeping system about your Medicare enrollment, benefit usage, status of claims and customer service venue.

If individuals need to order a replacement Medicare card, they can do so from MyMedicare.gov or from the Social Security Administration. If individuals have questions about Medicare, they can call 1-800-MEDICARE (1-800-633-42273) for personalized assistance.

  • To find a doctor who accepts Medicare in your area, you can search here.
  • To find and compare information on hospitals accepting Medicare (non-VA), click here.
  • To compare Medicare approved nursing homes, click here.
  • To compare Medicare approved home care agencies, click here
  • To compare Medicare approved dialysis centers, click here
  • To download the current Medicare and You handbook, click here.
  • To talk to a Medicare Counselor for more information or specific questions, please contact our office at 303-333-3482.