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

How Does Original Medicare Work

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.

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 and is 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 or have been diagnosed with ESRD.

What Original Medicare Covers

Part A is your hospital insurance and covers inpatient hospital stays, skilled nursing facility care, and certain home health care. Part B is your medical insurance and 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.

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, there are supplemental Medicare plans available. You can either enroll in a Medicare Advantage plan or Medigap plan. It’s important to know that both work very differently. Medicare is broken down into parts, Medigap is broken down into plans.

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 that will allow you to leave your Medicare Advantage plan and switch back to Original Medicare.

How to Get Supplemental Insurance that Works with Medicare

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 so you can get peace of mind on your Medicare coverage. You can also use our online rate form to see plans in your area now.

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.