Original Medicare is thefederal health insurance program primarily for people aged 65 and older, as well as some younger individuals with certain disabilities or health conditions (such as End-Stage Renal Disease or ALS). It consists of two main parts:
Generally premium-free for most people. It covers inpatient hospital stays and skilled nursing facility care. However, there is a large deductible for hospital stays and daily copayments for skilled nursing care after 20 days.
Part A
Hospital and Skilled Nursing
Part B
Doctor Visits and Other Medical Care
You pay a monthly premium for it- there is a 20% coinsurance and an annual deductible. There is no Max out-of-pocket.
Original Medicare also does NOT include prescription drug coverage which is known as Part D of Medicare.
To Recap the above information: Original Medicare is made up of Part A and B, and it only provides 80% coverage, there is no max out-of-pocket. Meaning there is a lot of out-of-pocket exposure.
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80% Coverage only!
What can this look like: Let's say you have a heart attack and treatment costs $150,000 and you only have Original Medicare (Part A and B) you will be on the hook for 20% of the $150,000.
To help cover that 20% there is additional coverage offered by private insurance companies. You have a couple of different options to choose from:
Original Medicare + Medicare Supplement Also known as Medigap
Medicare Advantage (Also known as Part C)
** You can NOT have both options **
Pros:
-You typically only pay your monthly premium and deductible, with little to no additional out-of-pocket costs.
-Guaranteed issue when you first turn 65 and enroll in Part B (no health questions or denials).
-No network restrictions; see any doctor or hospital nationwide that accepts Medicare.
-No referrals needed for specialists.
-Great for Traveling accross the U.S
Cons:
-Monthly premiums can be higher.
-Does not include dental, vision, or hearing coverage.
-Prescription drug coverage is not included (requires a separate Part D plan).
Pros:
-Lower monthly premiums (many plans have $0 premiums).
-Combines medical and prescription drug coverage into one plan.
-Includes extra benefits like dental, vision, hearing, and wellness programs.
Cons:
-Network restrictions; you may need to use specific doctors or hospitals.
-Referrals are often required for specialists.
-Costs like copays and coinsurance can add up over time.
-Plan benefits and costs can change annually.
Original Medicare
**You are required to have Part D even if you are not on any Medication, or you will face penalties.**
Original Medicare also does NOT include prescription drug coverage which is known as Part D of Medicare.
Supplement Plan
Medicare Advantage Plan
If you do not have credible coverage, you must sign up for Original Medicare during your Initial Enrollment Period once you turn 65 to avoid lifetime penalties for Part B and Part D
Medical Debt forces thousands of retirees into bankruptcy each year...Don't let it happen to you!
If our clients have pre-existing conditions and they can afford it, we ALWAYS encourage a supplement plan because of this one time rule!
When you enroll in Part C, the government relinquishes its role in managing your Medicare benefits, and the private insurer administers your healthcare, often bundling Parts A, B, and sometimes D, along with additional benefits.
When is my initial Enrollment Period?
You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage be-gins the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in and are paying for Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed.
It's important to know when & how you can enroll to avoid penalties or miss opportunities.
Medicare Frequently Asked Questions
Do I need to sign up for Medicare if I am still working past 65?
It depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.
If you're self employed and don't have 'credible' group health coverage (as defined by the IRS) then you will need to enroll in Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty
If your employer has less than 20 employees you will need to sign up for Medicare when you turn 65
If you have COBRA you will need to sign up for Medicare when you turn 65 to avoid a monthly part B late enrollment penalty
Do I need to get Medicare drug coverage (Part D) if I'm not taking any prescriptions?
YES! Even if you are not utilizing the benefits, you must maintain creditable drug coverage to avoid the Part D late enrollment penalty
How much does Medicare Cost?
Part A - is "premium free" for most people (who paid Medicare taxes at least 10 years) but there is a deductible of $1,632 for each time you are admitted to the hospital and a daily copayment if you are confined beyond 60 days and a daily copayment for skilled nursing facilities beyond 20 days
Part B - has a standard premium of $184.70 each month (higher income earners will also pay an Income Related Monthly Adjustment Amount (IRMAA) in addition to the standard premium); you might pay a penalty if you don't sign up for Part B when you're first eligible. The deductible is $240 each year before Medicare starts to pay plus you'll usually pay 20% of the cost for each covered service thereafter
Parts C, D and Medigap - Monthly premiums vary based on which policy you buy, where you live, and other factors. The amount can change each year. It is very important to talk to a qualified professional to help you navigate these choices, it’s highly recommended you do not enroll on your own without guidance. Please give us a call at 720.456.8007 to support you with choosing a plan and enrolling into Medicare.
How does Medicare enrollment work?
You only need to sign up for Part A and Part B once. Each year, you can choose which way you get additional coverage (and/or switch drug plans). Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse, either. It is recommended you review your Medicare options annually at the allotted time (Oct 15 - Dec 7)
