Original Medicare

ORIGINAL MEDICARE

Original Medicare covers Part A (Hospital Insurance) and Part B (Medical Insurance). You must be signed up to be enrolled  into Part A and Part B. Original Medicare will only pay 80% of Medicare approved services.  You will be responsible for the remaining 20% coinsurance, yearly deductibles, copays and there is No maximum out of pocket. Original Medicare do not cover prescription drugs and hearing, vision,  dental and no extra benefits offered. You will need to purchase a stand-alone Prescription Drug plan (Part D) which has a yearly deductible.  Referrals are not required or needed to see any doctor, specialist, or  hospital Nationwide that accepts Medicare.  To supplement your deductibles,  copays and coinsurance, you may  purchase a Medigap also known as Medicare Supplement.

Part A – HOSPITAL INSURANCE

If you or your spouse paid into Medicare taxes for 40 quarters (equivalent to 10 years), you are eligible to receive Part A coverage with No Premium.  If you do not qualify for a No Premium Part A you may have to pay a monthly standard premium of $458 or less depending on the quarters you have paid into the Medicare taxes. 

In general, Part A  Hospital Insurance covers facilities such as:

• Inpatient care in a hospital
• Skilled nursing facility care
• Nursing home care (not custodial or long-term care)
• Hospice care
• Home health care

*This is not a complete list of services available.

Part B – MEDICAL INSURANCE

Everyone will have to pay for Part B Monthly Premium except for certain people who are qualified to receive extra help. It is automatically deducted from your benefit payment if you get benefits from one of the following otherwise, you will  get a bill. 

• Social Security
• Railroad Retirement Board
• Office of Personnel Management

This current year 2021, the standard Part B premium you have to pay each month is $148.50. If your Modified Adjusted Gross Income (MAGI) is above $88,000, you may have to pay an IRMAA, Income Related Monthly Adjustment Amount. Medicare uses the MAGI reported on your IRS tax return from 2 years ago and are provided to Social Security by the IRS. You may have to pay a higher premium based on your income or if you don’t enroll when you are first eligible. 

In general, Part B covers Medical Insurance such as Medically Necessary Services and Preventive Services.  These are some of the things Part B covers:

• Clinical research 
• Ambulance services
• Durable medical equipment (DME)
• Mental health
• Limited outpatient prescription drugs

*This is not a complete list of services available.

For more information, book an appointment today so you can discuss your Medicare needs with a qualified licensed insurance agent.