Original Medicare

Medigap Planners

I'm covering retirement health insurance in four parts:

1. Original Medicare,
2. Medigap, a private Medicare supplement,
3. Medicare Advantage, and
4. Typical Medicare insurance bundles.

After paying off our home mortgage our standard deduction was higher than our itemized. After retiring the itemized was higher, mostly from buying health insurance.

See the Expanded Medicare Glossary for help with any unfamiliar terms.

In Original Medicare, Part A (Hospital) is paid by previous payroll deductions, and Part B (Medical/Doctor) premiums are standardized, but these plans only cover 80% of hospital and doctor costs.

Medicare Parts A and B are sometimes called original, traditional or fee-for-service Medicare to differentiate from Medicare Advantage health maintenance organization (HMO) or preferred provider organization (PPO) plans. Original Medicare is usually bundled with private supplemental (Medigap) and drug insurance plans to increase coverage.

Enrollment¹

• The Initial Enrollment Period for Part A and Part B runs from 3 months before to 3 months after the month you turn 65. If you're continuing on employer or union coverage after 65, you should apply for Part A during the initial period, and Part B during a Special Enrollment Period, starting the month after the employment or insurance ends, whichever comes first. Failure to sign up for Part B during these periods has a late enrollment penalty that will increase your Part B premium forever.
• 40 quarters of employment with Medicare payroll deductions automatically qualifies you for Medicare Part A (Hospital) with no monthly premium.
• Medicare Part B (Medical/Doctor) requires the payment of a monthly premium.

Access to Services¹

• You can go to any doctor or hospital in the United States that accepts Medicare; there is no network.
• There are no referrals for specialists and no prior authorization for services.

Costs¹

• A monthly premium for Part B (Medical/Doctor), deductibles, and coinsurance or copays.
• An out-of-pocket maximum or cap can be purchased with private Medigap supplement insurance.
• Purchase Part D drug coverage separately.

Benefits

• "Medically necessary health care services" as determined by Medicare. These are services or supplies needed to "diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine."
• Medicare Part A and Part B does not cover the following (although some may be included in a Part C Advantage plan): long-term care (also called custodial care), most dental care, eye examinations for prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids and exams, and routine foot care.³

2018 Original Medicare (Parts A and B) out-of-pocket costs 2
Part A premium	Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you have to pay for Part A, it can be up to $422 each month. See Calculate my premium for more details.
Part A hospital deductible and coinsurance	You pay: $1,340 deductible for each benefit period (day of admission to 60 days after your last inpatient care.) Days 1-60: $0 coinsurance for each benefit period Days 61-90: $335 coinsurance per day of each benefit period Days 91 and beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: all costs
Part B premium	The standard Part B monthly premium amount is $134 (or higher depending on your income). However, some people who get Social Security benefits will pay less than this amount ($130 on average in 2018).
Part B deductible and coinsurance	Your deductible is $183 per year. After you pay the deductible, you typically pay 20% of the Medicare-approved amount as coinsurance for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

Next: Medigap, a private Medicare supplement

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Expanded Medicare Glossary

Resources

References

¹ "Choosing Between Traditional Medicare and a Medicare Advantage Plan", Center for Medicare Advocacy, retrieved August 7, 2016.
² "Medicare 2018 costs at a glance", Centers for Medicare & Medicaid Services, retrieved November 27, 2017.
³ "What Part A & Part B doesn't cover", Centers for Medicare & Medicaid Services, retrieved December 1, 2017.