Original Medicare
Original Medicare Basics
Original Medicare is a federal insurance program geared towards those age 65 and older, suffering from End-Stage Renal Disease, or those receiving disability insurance. Original Medicare consists of Parts A and B. These parts of Medicare have different costs, and cover specific medical services. Click on the arrows below to view more information.
Part A & Part B Cost
Generally, Part A has no cost. If you’ve paid into Medicare through your payroll taxes during your working years, you are eligible for premium-free Part A.
- As long as you have worked at least 40 quarters (equal to 10 years) in your lifetime, you won’t pay for Part A.
- If you are not eligible for Part A due to not having enough work credits, you can still purchase Part A.
- Legal residents and those that have had a Green Card for at least five years can also purchase Part A.
Part B requires paying a monthly premium. The standard Part B premium in 2023 is $164.90/month. If you receive benefits from Social Security, Railroad Retirement Board, or the Office of Personnel Management, your Part B premium will be deducted from your payments. Most people fall into the bracket of paying the standard premium amount. Some exceptions are:
- If your modified adjusted gross income is higher than the standard bracket, you will pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare will use your IRS tax return from two years ago to determine your IRMAA.
- If you fall into a lower income bracket, you could possible qualify for the Medicare Savings Program (MSP), which may help you pay your Part B premium.
Part A & Part B Coverage
- Inpatient hospital care: This includes all care you receive after being admitted into a hospital by a physician. Medicare covers up to 90 days each benefit period in a general hospital. In addition, you receive 60 lifetime reserve days. It also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
- Skilled nursing facility care: Medicare covers your room, board, and certain services provided in a skilled nursing facility. This includes medications, tube feedings, and wound care. It covers up to 100 days each benefit period. To qualify, you must have spent at least three consecutive days in the hospital within 30 days of admission to a skilled nursing facility and must have needed skilled nursing or therapy services.
- Home health care: Though it is normally covered by Part B, Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily care are covered or an unlimited amount of intermittent care.
- Hospice care: Hospice care is covered for as long as your provider certifies it is necessary.
- Provider services: Services deemed medically necessary are covered under Part B.
- Durable medical equipment: Equipment that serves a medical purpose, able to withstand repeated use, and appropriate for home use, is covered.
- Home health services: If you are homebound and need skilled nursing or therapy care, you’re covered under Part B.
- Ambulance services: Emergency transportation by ambulance. Limited coverage for non-emergency transportation is available in which there is no safe alternative as long as it is medically necessary.
- Preventative services: Outpatient physical, speech, and occupational therapy services are covered as long as they are administered by a Medicare-certified therapist.
- X-rays and lab tests: All doctor ordered x-rays and lab tests are covered.
- Chiropractic care: Only when medically necessary to fix subluxation of the spine.
- Certain prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, antiemetic, dialysis, and other typical drugs administered by a physician.
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