What is Medicare?

Get the free New to Medicare Guide

In short, Original Medicare is a federally-funded health insurance program for those 65 and over, or otherwise qualified.

Here’s what you need to know:

  • There are two parts of Part A hospital insurance, Part B medical insurance
  • Covers 80% of medical expenses after deductible is met
  • Most people are automatically enrolled on 65th birthday

Who’s eligible?

  • Most American 65 and over are eligible for Medicare
  • Some people under 65 are eligible too if they have certain disabilities or illnesses

Many people are enrolled automatically and can expect their Medicare cards in the mail 3 months before their 65th birthday. 

If you are still working, or otherwise have creditable health insurance, you might want to delay enrollment in Part B of Original Medicare. Most people who are still working do not typically delay their Medicare Part A enrollment because it’s free for most Americans.

Here’s how to tell if you’re eligible:

I’m younger than 64

If you are under 65, you still may qualify for full Medicare benefits if:

You are entitled to Social Security Disability benefits for at least 24 months (can be nonconsecutive)

You receive a disability pension from the Railroad Retirement Board and meet certain conditions

You have ALS (amyotrophic lateral sclerosis), also called Lou Gehrig’s disease

You have End-Stage Renal Disease (ESRD)

I’m turning 65 or over 

Generally, you qualify for Medicare if you are 65 or older.

You can enroll in Medicare and other extra coverage up to 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65. This is called your Initial Enrollment Period.

If you’re older than 65 and losing coverage through work, you can enroll during a special enrollment period.

What does Original Medicare cover?

Medicare Part A

Medicare Part A, also called “hospital insurance”, covers things like inpatient hospital care, hospice, home healthcare, and more.

Most people don’t have to pay a monthly premium for Medicare Part A. This is because you’ve already paid into the system in the form of Medicare tax deductions on your paycheck. 

But Part A doesn’t cover everything and it isn’t totally free. In 2021, you must pay a deductible of around $1,484 before Medicare Part A kicks in and starts paying for your care. After that, you can expect Medicare Part A to cover about 80% of inpatient care during that benefit period.

Medicare Part B

Everyone pays a monthly premium for Part B. Part B usually costs around $148.50  for those new to Medicare as of 2021. You will also have to make other cost-sharing payments for care, like a deductible, copays, and coinsurance. Similarly, you can expect Part B to pay up to 80% of covered care.

People who are still working or covered by their spouse’s health plan may want to delay their Part B enrollment. However, if you delay your enrollment and do not have creditable coverage, you may have to pay a higher monthly premium as a penalty for not signing up when you’re first eligible.

Should I enroll in both A & B?

You will need to decide whether or not you enroll. However, in order to prevent any gaps in coverage, you should make that decision before you turn 65, retire, or lose coverage from an employer plan.

Call us today to get an expert opinion and no cost consultation of your coverage options.