Original Medicare (Parts A & B)

Medicare Parts A and B (Original Medicare) are managed by the federal government. Some individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday.

Medicare Part A

Medicare Part A covers inpatient care provided in hospitals or skilled nursing facilities, home health care and hospice care for the terminally ill.

Part A – Costs

Premium There is no insurance premium for Part A if you or your spouse contributed to Social Security for at least 10 years. Otherwise, an option to buy Medicare Part A is available.
Deductible You must first meet a Part A deductible before Part A helps with your covered medical expenses, similar to how Medicare Part B works.
Copays A copayment or cost sharing may apply to specific services, such as extended stays in a hospital or skilled nursing facility.
Coinsurance

Part A has coinsurance for:

  • Inpatient hospital care lasting between 61 and 90 days total per benefit period.
  • Inpatient mental health care lasting between 61 and 90 days total per benefit period.
  • Skilled nursing care lasting between 21 and 100 days total per benefit period.

Coinsurance is also available for a limited number of additional days.

Part A – Limits and Considerations

Limits

The following coverage restrictions apply to Medicare Part A:

  • Inpatient hospital care is limited to 90 days total per benefit period.
  • Inpatient mental care is limited to 90 days total per benefit period.
  • Skilled nursing care is limited to 100 days total per benefit period.

For each type of care, you can receive coverage for 60 additional days throughout your lifetime. These are known as "lifetime reserve days."

Things to Consider

  • Coverage can be used anywhere in the United States.
  • Most hospitals in the U.S. participate in Medicare.

Medicare Part B

Medicare Part B covers doctor visits, durable medical equipment, speech therapy, occupational therapy, physical therapy, and other outpatient services.

Part B – Costs

Premium Medicare Part B has a monthly insurance premium that is based on when you enroll and your annual household income. This premium is commonly paid through Social Security withholdings. It is separate from the health insurance premiums you will pay if you choose Medigap, Medicare Advantage (Part C) or Prescription Drug Coverage (Part D).
Deductible You must first meet an insurance deductible before Part B helps with your medical costs.
Copays A copayment or cost sharing may apply to specific services, such as those received in an outpatient hospital setting.
Coinsurance You pay 20 percent for some medical services, such as doctor services, outpatient therapy and durable medical equipment.
Preventive Care No deductibles, copays or coinsurance are required for Medicare-covered preventive care services, such as annual wellness visits and mammograms for women.

Part B – Limits and Considerations

Limits

Under Medicare Part B, there are annual limits on services for physical therapy, occupational therapy and speech language pathology.

Things to Consider

  • Part B coverage can be used anywhere in the United States if you have Original Medicare and the physician accepts Medicare.
  • You can select any doctor in the United States who accepts Medicare patients.
  • Part B premiums and standard deductibles and cost sharing amounts generally change annually on January 1st.

Medicare Parts A and B – Enrollment

Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Parts A and B you can, if interested, select other coverage options (e.g. Medicare Advantage, Medigap, Part D, etc.) from approved private insurers.

Choosing Other Medicare Coverage

After you enroll in Medicare Parts A and B, you can choose a Medicare coverage option (such as a Medicare Advantage plan). You can change your coverage later, during the annual Open Enrollment Period. However, if you elect to receive Prescription Drug Coverage (Medicare D) coverage after your Initial Enrollment Period, a late enrollment penalty may be added to your insurance premium. Learn More

Late Enrollment and Changes to Medicare Coverage

Your Initial Enrollment Period provides a limited time window to enroll in Medicare Part A and Part B (Original Medicare). If you miss this enrollment period you can still enroll later, but you must manually apply for Medicare A and B, and some penalties may apply. There is no automatic enrollment outside of your Initial Enrollment Period.

Open Enrollment Period

October 15 through December 7

The Medicare Open Enrollment Period provides an annual opportunity to review, and if necessary, change your Medicare coverage. Below are some examples of changes that you can make during Open Enrollment:

  • Join a Medicare Advantage (Part C) plan.
  • Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
  • Change from one Medicare Advantage plan to another.
  • Add or change your Prescription Drug Coverage (Part D) plan if you are in Original Medicare.
General Enrollment Period

January 1 through March 31

The General Enrollment period offers an annual opportunity to enroll in Medicare Part A and/or Part B. If you enroll in Medicare during the General Enrollment Period, your coverage starts July 1. For example, you can:

  • Sign up for Original Medicare if you weren't automatically enrolled and missed your Initial Enrollment Period.
  • Enroll in Part B if you have opted out of automatic enrollment or dropped your coverage.

If you enroll in Part B after your Initial Enrollment Period, then you will spend more on your premium, unless you qualify for a Special Enrollment Period.

Special Enrollment Period

There are certain situations that may allow you to enroll in the Medicare program or Medicare options outside of the Initial and annual Open Enrollment Periods.

If you have coverage through your employer and that coverage terminates, you may be eligible for a Special Enrollment Period.

More information about Special Enrollment Periods is available on the Social Security website.