In the U.S., the federal government has made quality health care a top priority for seniors. Medical coverage, provided through Medicare, is available for most people once they turn 65—even earlier for those with a disability or End Stage Renal Disease. But, with many working parts, Medicare isn’t always straightforward, and seniors often struggle to understand how it works and how to make the best decisions about their healthcare options.
If you’re new to Medicare or will be turning 65 in the near future, taking some time to understand Original Medicare—what it covers, what it doesn’t, and if it’s right for you—is a smart way to make informed decisions about your health care.
Original Medicare
What It Is and How to Get It While Medicare contains several different parts, Original Medicare includes only Part A and Part B. Part A (health insurance) covers you for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some additional health care. Part B (medical insurance) pays for doctors’ services, outpatient care, medical supplies, and preventive services. Original Medicare (Part A and Part B) does not include coverage for prescription drugs, dental or vision care.
Out-of-Pocket Costs
For most people, signing up for Original Medicare is automatic. As long as you receive benefits from Social Security or the Railroad Retirement Bureau, or you have a disability, you will receive a red, white, and blue Medicare card by mail three months before your 65th birthday or your 25th month of disability. While Part A is free for most people, Part B is not and a monthly premium will be automatically deducted from your Social Security check. In 2023, the Part B standard premium amount is $164.90. Most people pay this amount.
In addition to a Part B premium, there are other out-of-pocket costs associated with Original Medicare. Deductibles, coinsurance, or copays can be costly, and amounts change yearly. Also, many seniors choose to add prescription drug coverage to Original Medicare, which means a Part D premium as well.
Note: you do not have to accept Part B coverage, and you may opt out of benefits by signing the back of your Medicare card and returning it by mail. If you are still working and receiving medical benefits from your employer or through a spouse, accepting Part A, but delaying Part B coverage until a later date may make sense. As long as you have comparable coverage, you may delay signing up for Part B without penalty. However, if you choose to opt out of Part B without adequate coverage when you do sign up, you will pay a late penalty.
Prescription Drug Coverage Is Separate
Coverage for prescription drugs is not included as part of Original Medicare but can be purchased as a standalone plan. Prescription drug coverage, also called Medicare Part D, is available to all Medicare recipients. If you need drug coverage, there are only two ways to get it:
- Purchase a Part D plan and add drug coverage to Original Medicare.
- Purchase a Medicare Advantage plan with prescription drug coverage included.
Enhancing Original Medicare With Additional Benefits
In many cases, seniors realize they need more coverage than Original Medicare provides. Sometimes, that means adding a prescription drug plan to cover the cost of medication. In other cases, it means adding benefits to help shoulder out-of-pocket expenses associated with Medicare, like coinsurance, deductibles, and copayments. Some seniors simply need more medical benefits, like dental and vision care.
Medicare Supplement insurance (Medigap) is available for seniors looking for help paying some or all of Medicare’s deductibles and coinsurance. Supplement insurance is sold through private insurance companies and is designed to help seniors minimize out-of-pocket costs. Medicare Advantage (Part C) is also available with benefits above and beyond Original Medicare, like vision, dental, and prescription drug coverage.
References:
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html
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