Original Medicare
Original Medicare is the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service Medicare. Under Original Medicare, the government pays directly for the health care services you receive.
Medicare Eligibility
You are eligible for Original Medicare (Parts A & B) if you are the age of 65 or older, and some individuals under 65 with certain disabilities or conditions such as end-stage renal disease (ERSD) or amyotrophic lateral sclerosis (ALS) aka (Lou Gehrig's disease). Individuals also may be eligible if they are certified as medically disabled by the Social Security Administration after 24 consecutive months.
Medicare Enrollment
Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. You may enroll in Part A, Part B or both. You may also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D).
Annual Enrollment Period: October 15th – December 7th
During annual enrollment you can add, drop, or switch your Medicare coverage. The last change made during this period will take effect January 1st .
Medicare Advantage Open Enrollment Period: January 1 – March 31
If you are already a Medicare Advantage plan member, you may disenroll from your current plan and switch to a different Medicare Advantage plan one time only during this period or drop your Medicare Advantage plan and return to Original Medicare and enroll in a Prescription Drug plan.
Special Enrollment Period
Depending on certain circumstances, you may be able to enroll in a Medicare plan outside of the initial enrollment or annual enrollment time frames. Some ways you may qualify for a Special Enrollment Period are if you: Retire and lose employer coverage, Move out of the plan’s service area, Receive assistance from the state, Diagnosed with certain qualifying disabilities or chronic health conditions, or Qualify for Extra Help.
Medicare Part A
Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility.
In general, Part A covers:
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Inpatient care in a hospital
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Skilled nursing facility care
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Inpatient care in a skilled nursing facility (not custodial or long-term care)
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Hospice care
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Home health care*
You must meet certain conditions to get these benefits. Medicare Part A covers the hospital charges and most of the services you receive when you are in the hospital. But it does not cover the fees charged by doctors who participate in your care while you are in the hospital. Medicare Part B helps pay those costs.
What Does Medicare Part A Cost?
Majority of individuals do not pay a monthly premium for Part A if they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration Hospital Insurance. This is sometimes called “premium-free Part A.”
You can get premium-free Part A at 65 if:
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You already get retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to get Social Security or Railroad benefits but have not filed for them yet. You or your spouse had Medicare-covered government employment
If you are under 65, you can get premium-free Part A if:
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You received Social Security or Railroad Retirement Board disability benefits for 24 months.
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You have been diagnosed with End-Stage Renal Disease (ESRD) and meet certain requirements.
Part A Premiums
Individuals age 65 and older who do not meet the 40 quarters can voluntarily enroll in Medicare Part A. Individuals with at least 30 quarters of coverage buy Part A at a reduced monthly premium rate, which will be $278 in 2024. Individuals who have less than 30 quarters will pay the full premium, which will be $505 a month in 2024.
Part A Deductible and Coinsurance Amounts for Calendar Year 2024
Types of cost sharing
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Inpatient hospital deductible: Days 1-60 $1632 (deductible can be up to 5 times / year)
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Daily Coinsurance for 61st – 90th day: $408 per day (out of pocket up to $12,240)
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Daily Coinsurance for Lifetime Reserve 91st – 150th day: $816 per day (out of pocket up to $48,960)
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Skilled nursing facility daily coinsurance (days 21-100): $204 per day (out of pocket up to $16,320)
Medicare Part B
Part B is medical coverage is covers 2 types of services – Medically necessary services and Preventive services
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Physicians’ services (office visits, surgeons)
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ER/Urgent Care
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Radiology / Labs
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Ambulance (ground / air)
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Outpatient hospital services
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Certain home health services
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Durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Part B Premiums
The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024. Most individuals will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years prior. This is the most recent tax return information provided to Social Security by the IRS.
If your yearly income in 2022 (for what you pay in 2024) was:
Your monthly Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:
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Social Security
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Railroad Retirement Board
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Office of Personnel Management
If you do not get these benefit payments, you will receive a bill to pay your premium.
Part B Deductible and Coinsurance Amounts for Calendar Year 2024
2024 Annual Deductible for covered service is $240.00, once the deductible is reached you will then pay 20% of approved amount for covered services.
Medicare Assignment
On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment”. This means the patient will not be required to pay any of the expenses in excess of Medicare’s “approved” charge. The patient pays only 20% of the “approved” charge not paid by Medicare. Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for the covered services. In 2024, the most a physician can charge for services covered by Medicare is 115% of the fee schedule amount for non-participating physicians.
