Learn about Original Medicare

Original Medicare refers to coverage managed by the federal government. When you choose Original Medicare, you get the coverage included in Medicare Parts A and B, which help cover hospital and medical care costs. Learn more with Blue Cross Blue Shield of Michigan.

How Parts A and B work together

Part A

Medicare Part A helps pay for certain hospital expenses. Part A has an annual deductible and coinsurance on some services. Most people don't pay a monthly premium.

Benefits include
  • Inpatient hospital care

  • Skilled nursing facility care

  • Hospice care

  • Home health care

Part B

Medicare Part B helps you pay for your medical expenses. After you meet your Part B deductible, you will typically pay about 20% of the approved cost for covered services. Part B has a monthly premium.

Benefits include
  • Ambulance services

  • Mental health services

  • Getting a second opinion before surgery

  • Services that help treat, diagnose or prevent a condition or illness

How private insurance enhances Original Medicare

There are four parts to Medicare: A, B, C and D. Original Medicare consists of Parts A and B. Part A covers hospitalization and Part B covers outpatient care like doctor visits.

If you choose only Parts A and B, you would have Original Medicare. You'll still have many gaps in coverage and out-of-pocket costs, however. That's where private insurance options like Medicare Advantage can help protect you.

Read our Plan Comparison Guide (PDF) to learn more.

First, remember Medicare Part A and Part B are what makes up Original Medicare. Part C is known as Medicare Advantage.

Medicare Advantage plans come from private insurance companies contracting with the federal government to provide all the rights and benefits of Part A and Part B — along with added benefits like dental, vision, hearing and prescription drug coverage.

Unlike Original Medicare, Medicare Advantage plans also have an annual out-of-pocket maximum, after which the plan will pay 100% of your covered expenses.

Medicare supplement insurance, also known as Medigap, helps cover your portion of the costs not covered by Original Medicare.

Depending on the plan, Medicare supplement helps to cover some or all of Original Medicare's 20% coinsurance and deductibles. People who choose these plans must first sign up for Original Medicare and can add a stand-alone Part D drug plan.

Medicare Part D plans are also known as prescription drug plans.

Various private companies can offer Part D plans, and they help pay for many of the prescription drug costs not covered by Original Medicare Part B.

Original Medicare Part B covers only a limited number of outpatient drugs under limited conditions. If you have Original Medicare, you can purchase a stand-alone Part D plan to help cover your medications.

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Original Medicare eligibility and enrollment

You're eligible for Medicare if any of these apply:

  • You're 65 or older. 
  • You have a long-term disability and have been on Social Security for more than two years. 
  • You have end-stage renal disease. 
  • You have Lou Gehrig’s disease, also known as ALS. 

Your initial enrollment period is the first opportunity to sign up for Medicare and lasts for seven months. It begins three months before your 65th birthday and ends three months after your 65th birthday. For example, if your birthday is in May, you could sign up between February and August.

During this time, you can sign up for Medicare Parts A and B and add on Part D prescription drug coverage, a Part C Medicare Advantage plan or a Medicare supplement plan.

If you miss your chance to sign up during your initial enrollment period, you can sign up for Parts A and B during the open enrollment period, which is Jan. 1 to March 31, although you may have to pay a late enrollment penalty. You can then sign up for Medicare Advantage or a prescription drug plan during the annual enrollment period, which is Oct. 15 to Dec. 7.

You may also qualify to enroll during a special enrollment period. There are many scenarios that warrant a special enrollment period, but the most common is that you were still working and had creditable coverage through your employer, or had coverage through your spouse’s employer, when you first turned 65. You can sign up for Parts A and B as well as add on additional coverage during that time.

There may be penalties, but there are also exceptions which we will cover here. Let's take it part by part.

Part A late enrollment penalty

Most people won't face a penalty for late enrollment in Medicare Part A because they've worked more than 10 years, qualifying them for free Part A.

If you don't qualify for free Part A, then you will face a financial penalty.

Your premium for Part A will be 10% higher for twice the number of years you were eligible for Part A but didn't enroll. For example, if you delayed enrolling for two years after becoming eligible, your premium will be 10% higher for four years.

Part B late enrollment penalty

Part B carries a premium for everyone, regardless of your work and tax history.

Late enrollment also carries a significant penalty. Your Part B premium will increase by 10% for each year you were eligible but didn't enroll.

For example, if you delayed enrollment for three years, your Part B premium would increase by 30% for the rest of your life.

Note: If you're still employed or covered by employer health insurance, there's no penalty. You'll still need to enroll during a special enrollment period when you no longer have that employer coverage.

Part D late enrollment penalty

There's a somewhat complicated formula for knowing what late enrollment will cost you with Part D. If you don't sign up for Part D within three months of signing up for Part A or Part B, here's what happens:

First, let's make some assumptions. Let's assume the average premium for Part D coverage is $30.

Now, let's assume you were six months late in signing up. Your penalty will be 1% of $30 times six, so $1.80 per month. You would pay that penalty for the rest of your life.

Note: You may not have to pay a penalty if you had health insurance through an employer when you first became eligible for Part B.

The eligibility requirements are the same as Original Medicare. Private insurers may have additional eligibility requirements when purchasing a Medicare Advantage, Medicare supplement or prescription drug coverage plan.

What's included with Original Medicare

Original Medicare covers some of the costs for hospital and medical care.

You can enroll in a separate Part D plan to cover prescription drugs or a Medicare Advantage plan that covers both medical and drug costs, as well as other services like dental, vision and hearing.

Here's a high-level overview of the coverage included in Original Medicare. Covered services may be subject to deductibles, copays or coinsurance.

  • Hospital care
  • Medical care
  • Coverage while traveling domestically

What's not included

Long-term nursing care, routine dental, routine vision, hearing aids and prescription coverage.

Original Medicare doesn't include dental or vision care, and it only covers a limited amount of outpatient drugs.

Medicare Advantage plans often include dental coverage such as basic cleanings and X-rays but typically have an annual coverage cap. These plans may include vision and hearing depending on the coverage details. Many insurance companies also offer buy-up options if you want more dental, vision and hearing coverage.

To get prescription drug coverage, you can purchase a stand-alone Part D prescription drug plan through a private insurance provider or get a Medicare Advantage plan that includes Part D coverage.

Original Medicare helps cover some — but not all — of the costs of medical care, so many people choose to add on more coverage through a private insurance company. If you want more coverage, you can enroll in a Medicare Advantage plan, Medicare supplement or prescription drug coverage plan during your initial enrollment period or your special enrollment period if you're eligible. Members can change their Medicare Advantage or Part D plan each year during the annual enrollment period.

Then you should talk to your employer before you turn 65. Depending on the size of the company, some employers may require you to take full Medicare benefits when you turn 65. With others, you can wait until you retire to enroll in Medicare.

If your employer doesn't require you to take full Medicare benefits, you may still want to enroll in Medicare Part A. That's because if you or your spouse paid Medicare taxes for at least 10 years while working, then you qualify for free Part A. It can serve as secondary insurance which may cover things your primary insurance does not.

You should make that decision about enrolling in Part A carefully though because once you enroll in Medicare, you can no longer contribute to a health savings account, also known as an HSA. So if you have a high deductible health plan through your employer and an HSA that you still want to contribute money to, then you should delay enrolling in Part A.

You may have heard about penalties for late enrollment in Medicare. In most cases, those won't apply if you're still working and covered by a group health plan or if you qualify for free Medicare Part A. 

Preventive services help you identify and treat health problems early so you can stay healthy.

These include exams, shots, lab tests and screenings, among others. Medicare Part B covers some preventive care services, although you may have a 20% coinsurance on services after you have met your deductible. If you have a Medicare Advantage plan, your private insurance provider will have a list of preventive services they cover.

If you choose a Medicare plan from Blue Cross Blue Shield of Michigan, which has the largest network of providers in the state, there's a good chance your doctor will be covered.

With a Medicare supplement plan, you can see any doctor who accepts Medicare. If your doctor doesn't accept Medicare, they can choose to accept you as a patient, but you’ll be responsible for payment.

With a Medicare Advantage plan, your doctor must participate in the plan's network. You can check whether your doctor is in our network with Find a Doctor.

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How much does Original Medicare cost?

For many Medicare recipients who have worked most of their lives, Part A of Medicare has no monthly premium. If you don't meet the minimum working requirements, you may have to pay a premium. Part A has a deductible and may have coinsurance for certain services. 

When it comes to Part B, most people pay the standard monthly premium. However, if your income is above a certain amount, you may have to pay a higher premium.

You can find this year’s monthly premium amount on medicare.gov. Part B typically has a 20% coinsurance on covered services after you meet the deductible.

Part A and Part B don't have an annual out-of-pocket maximum, which is a cap on how much you would pay for services each year.

Yes. Your modified adjusted gross income may determine how much you pay for certain parts of Original Medicare.

If you have a higher income, you may have to pay a higher monthly premium for Medicare Part B.

Original Medicare is designed to provide health care to all eligible individuals.

You can get help paying your Medicare premiums from your state government. You can also sign up for a Medicare Savings Program, which can help with monthly premiums, deductibles, coinsurance and copayments if you meet certain conditions.

Also, depending on your income, you may be eligible for Medicaid as well, which offers low-income families and individuals free or low-cost health coverage.

If you're receiving benefit payments from Social Security, the Railroad Retirement Board or the Office of Personnel Management, your Part B premium will be automatically deducted from your benefit payment.

If you don’t get one of these benefit payments, you’ll receive a Medicare Part B bill in the mail with instructions about your payment options, which include paying by check, money order, credit or debit. 

You can also set up automatic payments for your premiums through your bank or Medicare Easy Pay.

Ready to enroll?

Discover your Medicare options with Blue Cross Blue Shield of Michigan and Blue Care Network.

Important information about Medicare supplement plans

This is a solicitation of insurance. We may contact you about buying insurance. Blue Cross Medicare Supplement plans aren't connected with or endorsed by the U.S. government or the federal Medicare program.

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