Original Medicare – Part A and Part B


Original Medicare is health insurance managed by the Federal Government that allows you to see any Medicare provider. It requires you to pay deductibles, has coinsurance for some medical services and no cap on your out-of-pocket expenses. In most cases, it does not cover you outside of the United States. It also does not include a prescription drug or dental benefit. Most people look for additional coverage to cover some of the financial gaps or provide additional benefits. Some basics:

Medicare Part A – Hospital Insurance

  • Usually premium free if Medicare taxes were paid for 40 quarters
  • Provides some coverage for hospital and skilled nursing care admissions, some home health and hospice care
  • Has a deductible per benefit period for inpatient admissions

Medicare Part B – Medical Insurance

  • Covers medically necessary outpatient services and some preventive services like doctor visits, lab tests, outpatient hospital care and durable medical equipment
  • Your premium is determined by Social Security, using your Modified Adjusted Gross Income as reported on previous tax returns
  • Has an annual deductible
  • Requires you to pay 20% coinsurance for most medical services after meeting the annual Part B deductible
  • Medicare Part B can be deferred with no penalty if you can show proof of "creditable" coverage through an employer health plan (self/spouse) since becoming eligible for Medicare

How do you fill in the financial gaps or
expand the coverage provided by Medicare?

  • Your state will have many options to choose from. To enroll in a Medicare health plan, a beneficiary you must have Medicare A and B and continue to pay your Part B premiums
  • Options to consider include Medicare Supplement Plans or Medicare Advantage Plans (Medicare HMOs or PPOs)
  • Your decision will be based on your lifestyle, desire for flexibility to choose your providers, costs for medical services and prescriptions and additional benefits available

Through discussion and analysis, we can work with you to determine which options to consider at this point in your life as well as in future years!