Medicare is health insurance for older adults aged 65+, younger adults with disabilities, and people with End Stage Renal Disease (ESRD).
Original Medicare, sometimes called Traditional Medicare, refers to Medicare Parts A and B.
Medicare Part A Coverage: Hospital insurance
Medicare Part A is often called hospital or inpatient insurance because it pays for care in the hospital. Part A also pays some of the costs of stays at skilled nursing facilities, or health care at home. Finally, Part A also covers hospice care for people who are terminally ill.
Medicare Part A is funded by the payroll tax (FICA) that is deposited into the Hospital Insurance Trust Fund. Most people who have a personal or spousal work history and paid into Social Security do not have to pay a premium for Part A.
What does Medicare Part B cover?
Medicare Part B pays for physician services, outpatient hospital care, and home health care that Part A does not pay for. It also covers:
- Diagnostic and laboratory tests, such as X-rays and blood work
- Medical equipment, such as wheelchairs and hospital beds
- Orthotics (devices that support joints) and prosthetics (artificial body parts)
- Mental health care
- Ambulance services
- Preventive services
Part B is financed by Part B premiums (paid monthly by Medicare beneficiaries) and general revenues from the federal government.
Original Medicare costs and coverage
Original Medicare has strict rules about what services it can and cannot cover. For example, home health care services are only covered under very specific circumstances for those requiring specialized therapies. Likewise, Original Medicare does not cover routine dental, vision and hearing services.
Medicare Part B covers numerous preventive services to help seniors and adults with disabilities to stay healthy. These include an Annual Wellness Visit, cancer screenings, vaccines, and testing and management of chronic conditions.
All people with Original Medicare have costs such as premiums, copayments, and deductibles. (Find a table of Parts A & B costs in 2016.) For seniors and adults with disabilities who have limited incomes, the Medicare Savings Programs can help to pay for the costs of Original Medicare.
When to enroll in Original Medicare
Older adults who receive Social Security or Railroad Retirement Benefits will be enrolled automatically into Medicare at age 65. Others have to apply for Medicare through the Social Security Administration.
Younger adults with disabilities generally will be enrolled automatically following 24 months of Social Security disability benefits (SSDI), however, individuals with certain disabling conditions may be able to get Medicare sooner.
Several different enrollment periods exist for seniors wanting Medicare coverage. Each person gets an Initial Enrollment Period into Medicare around their 65th birthday. There are also Special Enrollment Periods, such as for those who continue to work past age 65 and keep their employer insurance, and an annual General Enrollment Period.
The date that Medicare benefits begin depends on when the individual enrolls, as this enrollment calendar illustrates.
Older adults turning 65 may be able to delay enrollment into Medicare under some circumstances, such as having existing coverage through an employer. The My Medicare Matters QuickCheck tool can help assess those circumstances and make appropriate recommendations.
How to enroll in Original Medicare
Contact the Social Security Administration online or at 1-800-772-1213 (TTY 1-800-325-0778) to enroll in Medicare. Social Security can also help with replacement of a lost or missing Medicare card.
Where to get additional information/assistance
Want to learn more about Medicare or get your questions answered? Use these resources:
- NCOA’s consumer education site My Medicare Matters walks through the different parts of Medicare, and when and how to enroll, and offers a Medicare QuickCheck tool to get advice for your personal situation.
- Your local State Health Insurance Assistance Program (SHIP) provides free, objective assistance to people with Medicare and their families. To find your SHIP, call toll-free 877-839-2675 or visit the SHIP TA Center website.