What is Original Medicare?

When people refer to “Original Medicare,” they are speaking to the major medical coverage you have via the federal government. This insurance is administered by the Center for Medicare & Medicaid Services (CMS). Typically, individuals are eligible for this coverage when they have satisfied one of the following:

• Reached their 65th birthday
• Been disabled for 24 months
• Been diagnosed with specific illnesses (ex: Lou Gehrig’s disease or ESRD)

Once an individual has enrolled in Original Medicare, the federal government will issue a red, white, and blue card that will contain their full name, their Medicare Number and the effective dates for Part A (hospital coverage) and Part B (medical coverage).

What does Original Medicare cover?

Original Medicare coverage is broken-down into two types: Part A and Part B. These types cover different things, have different premium costs, and different deductibles. The charts below provide an overview of coverage and costs for the year 2023 and can change at any time. Click here for additional details on what Part A covers and click here to see details on Part B coverage.

Part A of Original Medicare covers the following:

Part B of Original Medicare covers the following:

What does Original Medicare NOT cover?

The easiest way to think of Original Medicare is that it’s basic 80/20 coverage. There are many exceptions to this but for planning purposes, it’s a simple, relatively accurate way to consider it. When determining healthcare costs, you should prepare to pay the 20% Original Medicare does not pay in addition to other costs this basic insurance does not cover. Below is a list of what Original Medicare does not cover. For more information on what is not covered, click here.

How much does Original Medicare cost?

Costs for Original Medicare are determined by the federal government and are, typically, modified each year. Most people don’t pay a monthly premium for Part A of Original Medicare because they (or their spouse) paid Medicare taxes while working.

Original Medicare Part B, however, does have a monthly premium. Your premium will be determined by two factors: how you file your taxes and the modified adjusted gross income (MAGI) from your tax return from two years ago. So, if you are beginning Medicare coverage in 2023, they will consider your MAGI from your 2021 tax return. If your MAGI exceeds certain amounts, you will pay an increased amount for your Original Medicare Part B. This increased amount is called an Income Related Monthly Adjustment Amount (IRMAA). Below is a chart to help you determine your 2023 monthly Original Medicare Part B premium. For additional details on these costs click here.

How do I sign-up?

Contrary to what you may hear or read from various sources (its amazing what credible sources have this answer wrong), most people are NOT automatically signed-up for Original Medicare. Unless you are already receiving Social Security Benefits when you turn 65, have been disabled for 24 months, or have a qualified illness, you will need to take action to enroll in Original Medicare.

There are specific differences between being ELIGIBLE for Original Medicare and ENROLLING in Original Medicare. Just because you are eligible does not mean you must enroll. In order for you to understand these differences and determine when it’s in your best interest to enroll, please contact us. Do not assume you fall in a certain category without consulting a trusted professional who knows the rules and can clearly articulate the nuances. Lifetime penalties may apply if you make an ill-informed enrollment decision.

You can enroll in Medicare Part A and/or Medicare Part B in the following ways:

1. Online by visiting www.SocialSecurity.gov
2. By calling Social Security at 1 -800-772-1213 (TTY users call 1-800-325-0778). The office is open Monday-Friday from 7am to 7pm.
3. Visiting your local Social Security office. Click here to locate your nearest office.