Original Medicare

Original Medicare
Part A and Part B

Medicare is a federal insurance program geared towards those 65 and older suffering from End-Stage Renal Disease or receiving disability insurance. Original Medicare consists of Part A and Part B

If you fall into any of these categories, you are often automatically applied to Original Medicare (Parts A and B). This plan’s coverage options include:

Short-Term Hospital
Urgent and Nursing Facility Care Under Part A
Checkups
Preventative Services
Outpatient Care
Medical Supplies Under Part B

Dental, Vision and Hearing

Original Medicare, or Part A and Part B, covers short-term hospital and medical care. It does not, however, cover dental, vision, and hearing care. Some emergency care related to these categories may be covered, but checkups, hearing aids, dentures, etc. are not covered.

If you need additional coverage, it would be very beneficial to opt for a Medicare Advantage plan. These plans not only cover many out-of-pocket costs of Original Medicare, but also includes the dental, vision, and hearing care you need.

Coverage

Medicare covers a huge variety of healthcare needs. This coverage is, however, dependent on the plan you are under. To better understand the offerings of each plan, let’s summarize each part’s coverage

Part A Coverage

Hospital Inpatient Care (Up to 60 Days)
Nursing Facility Care (Up to 60 Days)
Nursing Home Care (Upon Approval)
Hospice Care (Upon Approval)
Home Health Services (Upon Approval)

Part B Coverage

in general, medical services including Durable Medical Equipment (DME), vaccines, etc. Here are just a few of the more specific coverage options:

Cardiac Rehabilitation
Limited Chiropractic Services
Ambulance Services
Diabetes Supplies
Durable Medical Equipment (DME)
Kidney Dialysis Services and Supplies
Outpatient Mental Healthcare
Physical Therapy
And Much More

Dental, Vision and Hearing

Eligibility

Your Medicare eligibility is dependent on three major factors—age, health status, and work history. While cost, coverage, and availability vary based on your plan, location and provider, your Medicare eligibility does not change. You are eligible for Original Medicare if:

You are a U.S. Citizen and 65 or Older
You Have End-Stage Renal Disease (ESRD)
You Have Lou Gehrig’s Disease
You are Receiving/Can Receive Social Security or Railroad Retirement Benefits
You or Your Spouse is a Government Employee
Are Under 65 and Have Received Certain Disability Benefits from the RRB for at Least 24 Months
Are Under 65 and Have Received Disability Benefits from Social Security for 24 Months or More

Premium-Free Medicare Part A Eligibility

A premium is a monthly payment given to your insurance provider. Those who receive Original Medicare are required to pay a premium on their Part B coverage. Many people, however, are eligible for premium-free Medicare Part A. You are eligible for premium-free Part A if:

You or your spouse worked and paid Medicare taxes for at least 10 years.
You are receiving or are waiting to apply for retirement benefits from Social Security or the Railroad Retirement Board.
You or your spouse had Medicare-covered government employment.

Under 65

You are eligible for Medicare under 65 years old if:

You have been diagnosed with End-Stage Renal Disease (ESRD)
You have received Social Security Disability Insurance (SSDI) checks for at least 24 months

For ESRD Medicare coverage to begin, you must currently be receiving dialysis treatments or have had a kidney transplant.

You must also have at least one of the following:

SSDI Eligibility
Railroad Retirement Benefits Eligibility
You, a Spouse, or a Parent Have Paid Medicare Taxes for a Sufficient Amount of Time

You are automatically enrolled in Original Medicare after you receive your 25th month of Social Security Disability Insurance (SSDI). However, if you suffer from Amyotrophic Lateral Sclerosis (ALS), your Medicare coverage will start without the two-year waiting period.

Those who qualify for SSDI will receive a Medicare letter when the required 24-month period of time has passed. If this does not happen, we recommend contacting the local Social Security office.

Because Medicare under 65 is health needs-based, you will not be denied coverage for any underlying health conditions. Even if your condition remains the same or degrades, your coverage will not change.

Cost

Part A Cost

Home Health Care: $0 for home health care services and 20% of the Medicare-approved amount for Durable medical equipment (DME).

Hospice Care: $0 for hospice care, no more than a $5 copayment for each prescription drug, 5% of the Medicare-approved amount for inpatient care. Room and board are not covered.

Hospital Inpatient Stays: $1,556 deductible for each benefit period, $0 coinsurance for each benefit period for the first 60 days, $389 coinsurance per day of each benefit period up to 90 days, $778 coinsurance per each “lifetime reserve day” after day 90 for each benefit period.

Mental Health Inpatient Stays: 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.

Skilled Nursing Facility Stay: $0 for each benefit period for the first 20 days, $194.50 coinsurance per day of each benefit period up to 100 days, all costs beyond 100 days must be paid out-of-pocket.

Premium-Free Medicare Part A

You are eligible for premium-free Medicare Part A if:

You are 65 or older and currently receive Social Security or Railroad Retirement Board (RRB) Benefits.
You are 65 or older and eligible for these benefits but have not yet applied.
You or your spouse are 65 or older and have/had Medicare-covered by government employment.
You are under 65 and received Social Security or RRB disability benefits for at least 24 months.
You are under 65 and have End-Stage Renal Disease (ESRD).

You will also receive premium-free Part A if you have worked and paid Medicare taxes for ten years (40 quarters). If you worked between 30 and 39 quarters, your Part A monthly premium in 2022 will be $274. If you worked less than 30 quarters, your monthly premium will be $499.

Part B Cost

Deductible Percentages: After your deductible is met, most pay about 20% of most doctor services, outpatient therapy, and durable medical equipment (DME). You pay $0 for clinical laboratory services.

Home Healthcare: $0 for home health care services and 20% of durable medical equipment (DME) costs.

Outpatient Mental Healthcare: $0 for depression screenings if accepted, 20% of the Medicare-approved amount for visits to your doctor or other healthcare providers, and additional copayments/coinsurance for outpatient visits.

You will also be required to pay a yearly deductible and monthly premium. The monthly premium you receive is dependent on your income. For Part B, the standard premium is $170.10, and the yearly deductible is $233.

Apply

Applying for Medicare does not have to be a difficult process. If you have been receiving disability benefits for two years or more regardless of age, you will automatically receive Medicare coverage. You are also automatically eligible if you are suffering from End-Stage Renal Disease (ESRD) or receive Railroad Retirement Board (RRB) benefits.

You can begin the Part A and B application process three months before you turn 65. If you apply 3 months after your 65th birthday, you may receive lifetime late fees. For these reasons, we recommend applying as soon as possible in order to avoid coverage gaps and additional costs.

This late penalty will also apply if you delay your application to Medigap and/or Part D prescription drug coverage. You may also apply for Medicare Advantage during any open enrollment period without additional fees.

Medicare Misty Is A Non-Governmental Agency

Original Medicare
Part A and Part B

Coverage

Eligibility

Cost

Apply

Medicare Misty Is A Non-Governmental Agency

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Original Medicare Part A and Part B

Coverage

Eligibility

Cost

Apply

Original Medicare
Part A and Part B