Table of Contents:

What is Medicare?
What is Medicare Part A?
Medicare Part A Coverage and Costs
What Is Medicare Part B?
Medicare Part B Coverage and Costs
FAQs About Original Medicare Parts A & B

Medicare A-B Glossary

Original Medicare: Original Medicare is comprised of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Deductible: The amount you must pay for health care or prescription drugs before other insurance (Original Medicare, a Medicare Advantage Plan or Part D drug plan, or other insurance) begins to pay part or all of costs.
Coinsurance: An amount, usually a percentage of total costs, you may be required to pay as your share of the cost for services after meeting your plan’s deductible.
Copayment: An amount you may be required to pay for covered procedures, medications, and other medical costs after meeting your plan’s deductible.
Premium: The periodic payment to Medicare, an insurance company, or a health plan for medical or prescription coverage.
Preventive Care: Health care to prevent illness or detect it at an early stage.
Medically Necessary Services: Services or supplies needed to diagnose or treat an illness, injury, condition, or disease. Services must meet accepted standards of medicine to be considered medically necessary.
Durable Medical Equipment: Medical equipment, such as a wheelchair or hospital bed, that’s ordered by a doctor for use in the home.

What is Medicare?

Medicare is a federal health insurance program for individuals aged 65 and older, or those with certain disabilities or specific medical conditions that are still younger than 65. It helps cover the costs for a range of healthcare services making it easier for Medicare beneficiaries to access medical care when needed.

What is Medicare Part A?

Medicare Part A is generally referred to as “hospital insurance.” It is half of Original Medicare, together with Medicare Part B.

How do I know Original Medicare is right for me? Learn more.

Medicare Part A Coverage and Costs

Each part of Original Medicare includes costs such as deductibles and coinsurance payments.

What Does Medicare Part A Cover?

Medicare Part A generally covers the following:

Hospital inpatient care
Skilled nursing facility care
Nursing home care
Hospice care
Home health care

Some services may only be covered for patients with certain conditions. It’s important to know that if you’re in a Medicare Advantage plan or another Medicare plan, your plan may have different rules.

If you’re not sure whether Medicare covers your care, services or supplies, talk to one of our licensed team members.

Read: What Is Medicare Part A and What Does it Cover?

Depending on your circumstances, there may or may not be a monthly premium for Medicare Part A. If you or your spouse has worked in the United States for a certain period of time, you will not have to pay a premium. In addition, if you are already receiving Social Security retirement or disability benefits, you will likely qualify for premium-free Part A.

Is There a Late Enrollment Penalty for Medicare Part A?

If you are eligible for Part A but don’t sign up right away, you may have to pay a late enrollment penalty. Your monthly premium could go up by 10%, and you’ll have to pay that higher premium for twice the number of years you didn’t sign up.

Read: Do I Have to Sign Up for Medicare if I Don’t Retire at 65?

What is Medicare Part B?

Medicare Part B is the other half of Original Medicare. Part B covers preventive care, and is therefore commonly referred to as “medical insurance.”

Read: What is Medicare Part B and What Does it Cover?

Medicare Part B covers two types of services:

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition, and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best.

Medicare Part B Coverage and Costs

Medicare Part B can be categorized as medical insurance. It may cover items such as clinical research, ambulance services, durable medical equipment (DME), mental health, and limited outpatient prescription drugs. Part B costs are dependent on a couple different factors.

Your base premium is a monthly payment that is determined by your income. After you pay your deductible for the year, you will typically pay 20% of the Medicare-approved amount for:

Doctor services
Outpatient therapy
Durable Medical Equipment (DME)

Read: Will Original Medicare Meet my Coverage Needs?

NOTE: Part B has a premium which can vary by your gross income from two years prior – so 2020 income would affect 2022 Part B rates.

Is There a Late Enrollment Penalty for Medicare Part B?

If you are eligible for Part B but don’t sign up right away, you may have to pay a late enrollment penalty. Your monthly premium could go up by 10% for each 12-month period you did not sign up when eligible. Therefore, the longer you go without Part B coverage the greater your penalty would be. You would then have to pay this penalty for as long as you have Medicare Part B.

Learn more about Medicare Penalties and How to Avoid Them

FAQs About Original Medicare Parts A & B

Who is eligible for Original Medicare?

Individuals age 65 or older are eligible for Medicare. People under 65 may also qualify if they have certain disabilities or specific conditions such as ESRD or ALS.

When does Medicare coverage start?

For most people, Medicare coverage begins on the 1st day of the month you turn 65. If you qualify due to a disability, coverage usually starts after 24 months of receiving disability benefits. If your birthday falls on the first of any month, your benefits actually start the month before your birth month.

How do I sign up for Medicare Parts A & B?

Some individuals are automatically enrolled into Original Medicare Parts A and B, most others need to apply.

Get our How to Enroll in Medicare guide to learn more.

Does Original Medicare cover prescription drugs?

No, prescription drug coverage is not included. You can obtain drug coverage for prescription medications by enrolling in another Medicare-approved plan, such as a Medicare Advantage Plan (Part C) or adding a separate Prescription Drug Plan (Part D), also known as PDP.

What is not covered by Medicare Parts A & B?

Original Medicare (Parts A & B) does not cover all healthcare costs or medical services. Original Medicare does not have an annual maximum out-of-pocket (MOOP). Other exclusions include most dental, vision, and hearing care. However, standalone plans are available to cover these services, and many Medicare Advantage plans include them as part of their benefits.

Learn more about what’s covered and what’s not covered by Original Medicare.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Private insurance companies contracted by Medicare offer Medicare Advantage (Part C), which combines Part A and Part B, often with added benefits like Part D, vision, and/or dental.

How do I know if my doctor accepts Medicare?

To find out if your doctors accept Medicare, you can ask the provider directly or check the Medicare Compare Tool for participating providers. If you work with an insurance agent, like the Twin City Underwriters team, they can check for you.

Where can I get help comparing my Medicare options?

At Twin City Underwriters, we have been helping individuals with their Medicare health coverage decisions for over 50 years. As an independent agency of Medicare brokers, we represent nearly every insurance company in the Midwest and can help you compare many different plan options to choose the right coverage for you.

Reach out today to get started.

Get Personalized Help With Your Medicare Choices

Understanding Original Medicare is just the beginning. At Twin City Underwriters, our team of insurance professionals is here to answer your questions, compare options, and guide you toward the coverage that best fits your health and financial needs.

From navigating Original Medicare to comparing supplemental plans, we provide personalized guidance and ongoing support to help you make confident, informed decisions about your healthcare. We are proud to be the trusted Medicare Partner of countless individuals and families.

Connect with us today and take the next step toward Medicare coverage that works for you.

Original Medicare Parts A & B