Original Medicare
What is Original Medicare?
Original Medicare, also called “Traditional Medicare,” includes two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). It works on a fee-for-service basis, meaning you can go to any provider or hospital in the U.S. that accepts Medicare. When those covered services are billed, Medicare pays a portion*, and you pay the rest. While Medicare covers healthcare visits and medical supplies, it doesn’t cover all medical expenses or the cost of most long-term care.
*You generally have to pay a portion of the cost for each service Original Medicare covers. There’s no limit to what you’ll pay out of pocket in a year.
- Part A (Hospital Insurance): This part generally covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Part A (Premium): $0 for most people (because they or a spouse paid Medicare taxes long enough while working – generally at least ten years). You won’t pay a Part A premium if you get Medicare earlier than age 65. Sometimes called “premium-free Part A.” (If you don’t qualify for premium-free Part A, You might be able to buy it. You’ll pay either $278 or $505 each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes.)
- Part B (Medical Insurance): This part covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Part B (Premium): $174.70 monthly (or higher, depending on your income). The amount can change each year. You’ll pay the monthly premium even if you don’t get any Part B-covered services.
Who is eligible for Original Medicare?
Most people become eligible for Original Medicare when they turn 65. However, coverage is also available to younger people with a qualifying disability. Eligibility begins once they have been receiving Social Security disability benefits for two years. Younger people are also eligible if they’ve been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD).
Original Medicare:
- Original Medicare can be used anywhere in the U.S. as long as the provider accepts Medicare.
- Patients and their doctors generally do not need to obtain prior authorization for the majority of services.
- Coverage is the same (premiums and out-of-pocket costs) everywhere in the country.
- Original Medicare does not cap out-of-pocket costs, so supplemental coverage is recommended. (A Medicare Supplement (Medigap) policy may be able to pay nearly all of the out-of-pocket costs associated with Original Medicare.)
- Original Medicare does not cover prescription drugs (with a few exceptions), so separate drug coverage is recommended. (Medicare Part D)
- Original Medicare does not cover routine dental, vision, or hearing care that is not associated with other medical services.
- Combining Original Medicare, Medicare Supplement (Medigap), and Medicare Part D plan can result in coverage with less out-of-pocket costs.
Some people choose to receive their Medicare Parts A and B coverage through a Medicare Advantage Plan (Part C)*. They will still have Medicare, but they will get most of their Medicare Parts A and B coverage from their Medicare Advantage Plan, not Original Medicare.
*For more on Medicare Advantage Plans (Part C)
