What is Medicare?

What is Original Medicare and who qualifies?

The subject of Medicare can be very confusing, but as experts in helping people with the transition to Medicare, we are here to make it an easier process. Find out here about what Original Medicare is, what it covers, and how it works.

Original Medicare = Part A + Part B

First, Medicare is the federal health program for people 65 and older, people with certain disabilities, and people with End-Stage Renal Disease, or ESRD. Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Together, these two parts of Medicare will allow you to visit any doctor or hospital across the country that accepts Medicare and will work much like an 80/20 plan, where after meeting the annual deductibles for Parts A and B, Medicare will cover 80% of the bill for these medical and hospital services, and you will cover the remaining 20% as coinsurance. More generally, Medicare will cover everything that is considered medically necessary. This means that it will not cover cosmetic surgeries but only chiropractic or dental care under certain very limited circumstances.

Medicare doesn't cover everything

While Original Medicare will cover much of your hospital and medical needs, it still has many gaps in coverage that you are responsible for in terms of copays, deductibles, and coinsurance. Because of this, many people choose to buy a low-cost Medigap plan or Medicare supplement to help cover that 20% that Medicare doesn’t cover. To learn more about Medigap plans, check out our video series that covers all the Medigap policies available in detail.

Another thing to note is that Original Medicare also does not include prescription drug coverage; which means that you will need to separately purchase a prescription drug plan that is the same as Medicare Part D that is introduced into the Medicare program in 2004. Be sure to watch our next video on Medicare Part D to Get a clearer explanation about the prescription drug planes.

Medicare is not free

Finally, one of the most common myths is that Original Medicare is free. Unfortunately this is not true. Most people qualify for Medicare Part A without premium after they have worked and paid their social security taxes for a period of 10 years, which is equal to 40 quarts. However, Part B has a monthly premium that for most people is $148.50 per month, but this amount can vary based on your income.

(Watch our video on Medicare Part B to better understand what it covers and how much it can cost you).

Once you know you qualify for Medicare and are approaching your eligibility date or 65th birthday, you will need to prepare for your enrollment and transition. Our next video will talk precisely about the registration process, as well as, how, when and where to register. We also have a great video that includes 6 tips to help you prepare for your transition to Medicare. Be sure to find it on our YouTube channel so you can sign up early and avoid delays and penalties for not signing up when eligible.

Do you have any questions?

Contact us at 855-GO-AVILA and speak with one of our authorized and certified agents.