Original Medicare
(Part A and Part B)
Understanding The Basics
Medicare Part A and Medicare Part B are often referred to as Original Medicare.
Original Medicare is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest.
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. CMS is part of the U.S. Department of Health and Human Services.
What is Part A?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
How much does Part A cost?
Part A is premium free for most medicare eligible individuals
You can get premium-free Part A at 65 if:
You already get retirement
benefits
from Social Security or the Railroad Retirement Board.
You're eligible to get Social Security or Railroad benefits but haven't filed for them yet.
You or your spouse had Medicare-covered government employment.
If you're under 65, you can get premium-free Part A if:
You got Social Security or Railroad Retirement Board disability benefits for 24 months.
You have End-Stage Renal Disease (ESRD) and meet certain requirements.
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Contact Social Security for more information about the Part A premium.
What is Part B?
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
How much does Part B cost?
You pay a premium each month for Part B.
Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:
Social Security
Railroad Retirement Board
Office of Personnel Management
If you don’t get these benefit payments, you’ll get a bill.
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Most people 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 ago. This is the most recent tax return information provided to Social Security by the IRS.
The standard Part B premium amount in 2019 is $135.50. Most people will pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. This premium could be as high as $460.50 monthly.
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If you would like additional information on the Part B premium schedule based on income, please contact us to get a copy of the chart outlining premiums.
Part B deductible & coinsurance
You pay $185 per year in 2019 for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for these:
Most doctor services (including most doctor services while you're a hospital inpatient)
Outpatient therapy
Durable medical equipment (DME)
What Part B covers
Part B covers 2 types of services
Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.