Original Medicare is a federal health insurance program. It was created for individuals who are 65+ years old, individuals under 65 with certain disabilities, and individuals diagnosed with End-Stage Renal Disease.

What is Original Medicare?

Original Medicare consists of Part A, Part B, Part C, and Part D. Sometimes Original Medicare is referred to as traditional Medicare. Medicare is health insurance that’s managed by the federal government. Each part of Medicare comes with a monthly premium.

Part A is your inpatient coverage or coverage for any hospital visits. As long as you paid into Medicare for at least 40 quarters, you’re eligible for premium-free Part A.

Part B is your outpatient coverage or coverage for any doctor visits. Part B comes with a standard monthly premium. If you fall into a higher income bracket, you could pay more.

What is Medicare Part C & Medicare Part D?

Part D is your prescription drug coverage. Both Part B & Part D come with late enrollment penalties if you don’t enroll when you’re first eligible and don’t have another form of creditable coverage.

Part C works differently than the rest of the parts of Medicare. It’s managed through a private carrier instead of the government.

Who’s Eligible for Original Medicare?

You’re eligible for Original Medicare once you turn 65 years old. You’re also eligible if you’ve been collecting Social Security Disability Income for at least 24 months. O you’ve been diagnosed with ESRD.

What Does Original Medicare Cover?

Hospital insurance, or Medicare Part A, covers inpatient hospital stays, skilled nursing facility care, and certain home health care.

Your medical insurance, or Medicare Part B, covers doctor visits, outpatient care, durable medical equipment, and preventive services.

Part D is your prescription drug coverage, it also covers most vaccines.

Part C is Medicare Advantage. When you have Part C, the private carrier pays instead of Medicare.

Are there Coverage Gaps in Orignal Medicare?

Medicare does come with many coverage gaps. This includes deductibles, coinsurance, and copays.

Medicare, as of now, does not include coverage for dental, hearing, or vision. Additionally, Part B only covers 80% of medical services received in an outpatient facility.

The good news is, that there are supplemental Medicare plans available. You can either enroll in a Medicare Advantage plan or a Medigap plan.

It’s important to know that both work very differently. Medicare is broken down into parts, and Medigap is broken down into plans.

What does Original Medicare include?

Original Medicare is technically only Part A & Part B, which are standardized by the federal government. Part C & Part D is administered through private insurance carriers.

How to Switch Back to Original Medicare?

If you left Original Medicare & enrolled in a Medicare Advantage plan, you can switch back to Original Medicare during the Annual Enrollment Period.

If you had a change in circumstance, you may qualify for a Special Enrollment Period. This will allow you to leave your Medicare Advantage plan and switch back to Original Medicare.

How to Get Help with Your Original Medicare Coverage

If you’re currently enrolled in Part A and/or Part B and need to fill in the gaps in coverage, give us a call. Our agents will see what supplemental Medicare plans are available in your area. This will give you peace of mind about your Medicare coverage. You can also use our online rate form to see plans in your area now.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.