Original Medicare - Parts A and B

Original Medicare - Part A and Part B

Original Medicare falls under two main parts, Part A and Part B.  Original Medicare sometimes goes by the name “traditional” Medicare, so don’t let this confuse you because it is the same thing.

Part A

Part A of Medicare covers inpatient hospital stays, hospice care, and home health care. This part of the program is designed to provide medical care when individuals need it the most, especially during a hospital stay. It also covers hospice care for terminally ill individuals and home health care.
However, it does not include long-term care services such as help with daily activities like bathing or clothing.

Part B

Part B of Medicare covers doctor visits, preventive care, and outpatient services. This part of the program allows individuals to receive care from their healthcare providers, covering preventive care services such as annual check-ups and screenings, as well as outpatient services like diagnostic tests and surgeries. Part B also covers mental health outpatient services and durable medical equipment such as walkers and wheelchairs.

Medicare Eligibility and Enrollment Period

To qualify for Original Medicare coverage, beneficiaries must:

  • be a U.S. citizen or legally admitted citizen who has lived in the States for at least five years

  • be 65 or older

  • younger than 65 but receive Social Security Disability benefits for at least 24 months

  • have ESRD or ALS

If you received your Social Security benefits, you would be automatically enrolled in Part A and B when first eligible, but if you don’t, you will have to do it by yourself.

The best time to enroll in Medicare is when you are first eligible. This is called an Initial Enrollment Period, a 7-month open enrollment window that starts 3 months before you are 65 and ends 3 months after you turn 65. If you miss this open enrollment window, you must pay a late enrollment penalty fee as long as you have Medicare coverage. 

For example, for Part, A premium cost to be paid will be twice the number of years you were eligible but not enrolled in Medicare, and Part B costs are for each 12-month period you have not enrolled but are eligible.

However, most people qualify for “free part A premium” because you get a free part A monthly premium if you have worked and paid for Medicare taxes for at least 10 years or 40 quarters. You also can get this free premium if you are under your spouse’s coverage if your spouse worked long enough.

If you don’t qualify for Part A free premium, you still can buy Part A, and if you have worked for 30 quarters, your premium will be 278$ but if you have worked less than 30 quarters (7.5 years), you will have to pay the total cost which is 505$ in 2024.

However, all Medicare beneficiaries must pay Part B monthly premium, which is 174.70$ in 2024.

Medicare Costs

All Medicare beneficiaries need to be aware of the expenses related to their coverage. The standard monthly premium for Part B medical insurance amounts to $174.70 and is automatically deducted from Social Security benefits or invoiced if benefits are not received. However, higher-income beneficiaries pay a higher premium for Part B and Part D through Income-Related Monthly Adjustment Amount (IRMAA), with costs ranging from $69.90 to $419.30 for Part B and $12.90 to $81 for Part D. The standard deductible for Part D is $545, with a base beneficiary premium of $34.70. The Coverage Gap, known as the “donut hole,” commences once the total drug costs reach $5,030.

In 2024, the Part A deductible for hospitalization will be $1,632, while the Part B deductible will be $240. Medicare Advantage’s maximum out-of-pocket limit will be $8,300 for in-network services, and $12,450 for both in and out-of-network services, with a maximum deductible of $15,750 for Medical Savings Account (MSA) plans.

Medicare is a crucial program providing essential medical care to eligible individuals. Whether you are a first-time enrollee or looking to update your coverage, it is crucial to understand the program’s different parts and benefits. By selecting the right coverage, you can ensure that you receive the necessary medical care when needed and protect yourself against the high cost of healthcare.