Original Medicare

Medicare is a  U.S. federal government program regulated under federal law and provides health insurance for those who are 65 or older.

However, there are some exceptions,  because Medicare coverage also can get beneficiaries that are younger than 62, if they are receiving Social Security Disability benefits for at least 24 months, or have End-Stage Renal Disease or ALS.

Medicare typically consists of four parts, but Original Medicare falls under two main parts, Part A and Part B.  Original Medicare sometimes goes by name “traditional” Medicare so don’t let this confuse you because it is the same thing.

Medicare Eligibility And
Enrollment Period

To qualify for Original Medicare coverage beneficiaries must:

  • be a U.S. citizen, or legally admitted citizen who lives in the States at least for five years
  • be 65 or older
  • younger than 65 but receive Social Security Disability benefits at least 24 months
  • have ESRD or ALS

If you received your Social Security benefits you will be automatically enrolled in Part A and B when first eligible but if don’t you will have to do it by yourself.

The best time to enroll in Medicare is when you are first eligible. This is called an Initial Enrollment Period, and it is a 7-month open enrollment window that starts 3 months before you are 65 and ends 3 months after you turn 65. If you miss this open enrollment window, you will have to pay a late enrollment penalty fee, as long as you have Medicare coverage. 

For example, for Part, A premium cost to be paid will be twice the number of years you were eligible but not enrolled in Medicare, and Part B costs are for each 12-month period you have not enrolled but are eligible.

However, most people qualify for “free part A premium” because you get a free part A monthly premium if you have worked and paid for Medicare taxes for at least 10 years or 40 quarters. You also can get this free premium if you are under your spouse’s coverage if your spouse worked long enough.

If you don’t qualify for Part A free premium you still can buy Part A, and if you have worked for 30 quarters your premium will be 278$ but if you have worked less than 30 quarters (7.5 years) you will have to pay the full cost which is 506$ in 2023.

However, all Medicare beneficiaries are obligated to pay Part B monthly premium which is 164.90$ in 2023.

Original Medicare Costs

When you enter the world of Medicare, you will see that things that beneficiaries must pay come in form of premiums, copayments/coinsurance, and deductibles. So it is important to explain their definitions:

  • Premium: a monthly payment you make to the plan based on your needs, health, and amount of coverage.
  • Deductible: an annual fee you must meet to maintain your coverage (not included in your premium payment).
  • Copayment/Coinsurance: each time you use benefits from your plan, you will likely have to pay an out-of-pocket fee. This will either be a flat cost known as a copayment or a percentage of the total cost known as coinsurance.


The deductible for Part A is 1600$ each benefit period, and for Part B is 226$ in 2023. Since Original Medicare works on a cost-sharing principle, it only covers 80% of all services whilst beneficiaries are responsible for covering 20% in form of copayments/coinsurance.

However, there is no cap on this 20% so your out-of-pocket costs can be unpredictable end very high. But, you can buy a Medicare Supplement insurance plan, which basically helps Medicare beneficiaries to fill the gaps that are left by Parts A and B.

The monthly part B premium is basically 164.90$ but it can be higher for some beneficiaries due to IRMAA (Income-Related- Monthly- Adjustment Amount). Social Security will determine which beneficiaries qualify for IRMAA and how much will they pay based on a tax report from 2 years ago.

If you don’t have the same income status as 2 years before, you may file an appeal, Medicare experts can help you with information on how to do so.

Part A Coverage 

Original Medicare basically covers all services that are considered medical necessities.

Part A is your hospital insurance and covers all services that are related to inpatient care. Therefore, you will be provided with these benefits:

  • hospital inpatient care: if you are admitted to the hospital by a doctor’s order because of an illness or an injury. You have to cover Part A hospital deductible (1600$) for each benefit period. The benefit period ends when you didn’t get any hospital or SNF care for 60 days in a row, and the new period begins. From 0 to 60 days there is 0$ of coinsurance. From 61 to 90 is 400$ per day, and from 91 to 120 is 778$.
  • skilled nursing facility care: it is covered for a short period of time if you have days left on your benefit period to use, and have 3 consecutive days in an inpatient hospital stay 
  • nursing home care: this doesn’t include custodial care if is it only care that the patient needs 
  • hospice care: if you are terminally ill (with a life expectancy of 6 months or less)
  • home health care: part-time skilled nursing care, occupational therapy,  speech-language pathology services, etc. ( this doesn’t include 24-hour daycare in your home)

Part B Coverage

Part B covers most services that fall. under Original Medicare. It is your medical insurance that covers all benefits related to outpatient services and preventive care. It covers all medically necessary and preventive services. Therefore, these benefits include:

  • doctor visits/office visits: may need to pay 20% of coinsurance up to Medicare-approved amount
  • diagnostic tests
  • ambulance services: if transportation in any other vehicle endangers your health
  • durable medical equipment: like wheelchairs, walkers, scooters, etc. 
  • mental health services: one depression screening a year, family counseling,  medication management, physical evaluation, etc.
  • limited outpatient drugs: drugs used with durable medical equipment, some antigens, injectable osteoporosis drugs, ESRD drugs, vaccinations, immunosuppressant drugs (cancer), etc.
  • kidney dialysis
  • diabetes supplies 

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