If you're approaching Medicare eligibility or helping a loved one navigate their healthcare options, understanding Original Medicare is the first step. This foundational coverage is made up of Part A and Part B, and from there, you can choose between two main paths: a Medicare Advantage Plan (Part C) or a Medicare Supplement (Medigap) plan.
Let’s break it all down in simple terms.
What Is Original Medicare?
Original Medicare is the traditional government-run health insurance program for people aged 65 and older, or those under 65 with certain disabilities. It includes:
Part A – Hospital Insurance
What it covers:
- Inpatient hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health care
Part B – Hospital Insurance
Cost
- Premium: Free if you or your spouse worked and paid FICA taxes for at least 10 years (40 quarters).
- Deductible: There is a per-benefit-period deductible that changes annually.
- Copayments: You’ll pay a daily copay after a certain number of days in a hospital or skilled nursing facility.
Part B – Medical Insurance
What it covers:
- Doctor visits (primary care and specialists)
- Outpatient services
- Surgeries
- Durable medical equipment
- Preventive care
Cost:
- Premium: Based on your taxable income from two years ago.
- Deductible: Annual deductible applies.
- Coinsurance: After meeting the deductible, you typically pay 20% of the Medicare-approved amount for services.
What Comes After Original Medicare?
Once enrolled in Original Medicare, you have two main options to enhance your coverage:
Option 1: Medicare Advantage Plans (Part C)
Medicare Advantage Plans are offered by private insurance companies and replace your Original Medicare coverage.
Key Features:
- Often low or no monthly premiums
- You pay copays or coinsurance when receiving care
- Operate through networks (HMO or PPO)
- May include Part D (prescription drug coverage)
- Often include extra benefits like dental, vision, hearing, over-the-counter items, and fitness programs
Enrollment Tip: You can re-shop or switch Advantage Plans during the Annual Enrollment Period (AEP) from October 15th to December 7th each year.
Option 2: Medicare Supplement (Medigap)
Medigap plans work alongside Original Medicare to help cover out-of-pocket costs like deductibles, copays, and coinsurance.
Key Features:
- Monthly premium required
- May cover nearly all medical costs after you meet the Part B deductible
- No networks – see any provider that accepts Medicare
- Does not include prescription drug coverage (you’ll need a separate Part D plan)
- No dental, vision, or hearing coverage included
Enrollment Tip: You can apply for a Medigap plan any time of year, but outside of your initial enrollment period or without a guaranteed issue right, you may need to go through medical underwriting.
Need Help Navigating Medicare?
Choosing the right Medicare path can be complex, but you don’t have to do it alone. For more information or to speak with a local insurance expert, call URL Insurance Group at 717-323-2000.
