Original Medicare (Part A and Part B) is a federal health insurance program for people in the U.S. who are 65 and older as well as some younger people with disabilities, ESRD and ALS. Medicare beneficiaries can use any doctor or facility in the US that accepts Medicare.
With Original Medicare:
You go directly to the doctor or hospital when you need care. You do not need to get prior permission/authorization from Medicare or your primary care doctor.
You are responsible for a monthly premium for Part B. Some also pay a premium for Part A.*
You typically pay coinsurance for most services that you receive. Preventative health services, vaccinations, and other services are often without cost to the beneficiary.
There are limits on the amounts that doctors and hospitals can charge for your care. Doctors and hospitals that accept Medicare must also accept approved Medicare rates.
If you want prescription drug coverage with Original Medicare, you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).
But Medicare benefits do not pay for everything.
As you approach age 65, you will need to decide how to deal with some of those coverage gaps. For now, knowing the basics of how Medicare works can help you better understand some of the expenses you will be responsible for.
If you are receiving Social Security benefits when you turn 65, you will be enrolled automatically in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits. If you want Medicare Part D prescription drug coverage, you will need to enroll yourself — it is not automatic.
If you are not receiving Social Security benefits, you will sign up through the Social Security Administration website. You typically should do so in the seven-month window around your 65th birthday (which includes the three months before the month you turn 65, your birthday month, and the three months after your birthday month) to avoid permanent penalties.
*You do not have to pay premiums for Medicare Part A if you or your spouse paid Medicare taxes for at least 10 years. Otherwise, eligible people pay monthly premiums for Part A of up to $499 each month. The other part of Original Medicare, Part B which covers things like doctor visits, requires a monthly premium of $170.10 for most enrollees in 2022, adjusted upward in scale with higher earners and incomes.
Remember! Original Medicare does not pay for everything.
If you want Medicare Supplemental Insurance (Medigap), you will sign up during the six-month Medigap enrollment period, which starts the month you turn 65 and are enrolled in Medicare Part B. The private insurers who provide Medigap plans are required to enroll if you sign up during that guaranteed period. Otherwise, there is no guarantee they will sell you a Medigap plan in the future.
If you miss your initial window or want to switch plans later, there are several annual Medicare open enrollment periods.
To learn more about expanding your Original Medicare Plan coverage, see your options (link pages)