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Original Medicare (Parts A & B) 

Medicare Parts A and B (Original Medicare) are managed by the federal government. Some individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday.

Medicare Part A

Medicare Part A covers inpatient care provided in hospitals or skilled nursing facilities, home health care and hospice care for the terminally ill.

Part A – Costs

Premium There is no insurance premium for Part A if you or your spouse contributed to Social Security for at least 10 years. Otherwise, an option to buy Medicare Part A is available.
Deductible You must first meet a Part A deductible before Part A helps with your covered medical expenses, similar to how Medicare Part B works.
Copays A copayment or cost sharing may apply to specific services, such as extended stays in a hospital or skilled nursing facility.
Coinsurance

Part A has coinsurance for:

  • Inpatient hospital care lasting between 61 and 90 days total per benefit period.
  • Inpatient mental health care lasting between 61 and 90 days total per benefit period.
  • Skilled nursing care lasting between 21 and 100 days total per benefit period.

Coinsurance is also available for a limited number of additional days.

Part A – Limits and Considerations 

Limits

The following coverage restrictions apply to Medicare Part A:

  • Inpatient hospital care is limited to 90 days total per benefit period.
  • Inpatient mental care is limited to 90 days total per benefit period.
  • Skilled nursing care is limited to 100 days total per benefit period.

For each type of care, you can receive coverage for 60 additional days throughout your lifetime. These are known as "lifetime reserve days."

Things to Consider

  • Coverage can be used anywhere in the United States.
  • Most hospitals in the U.S. participate in Medicare.

Medicare Part B

Medicare Part B covers doctor visits, durable medical equipment, speech therapy, occupational therapy, physical therapy, and other outpatient services.
 

Part B – Costs 

Premium Medicare Part B has a monthly insurance premium that is based on when you enroll and your annual household income. This premium is commonly paid through Social Security withholdings. It is separate from the health insurance premiums you will pay if you choose MedigapMedicare Advantage (Part C) or Prescription Drug Coverage (Part D).
Deductible You must first meet an insurance deductible before Part B helps with your medical costs.
Copays A copayment or cost sharing may apply to specific services, such as those received in an outpatient hospital setting.
Coinsurance You pay 20 percent for some medical services, such as doctor services, outpatient therapy and durable medical equipment.
Preventive Care No deductibles, copays or coinsurance are required for Medicare-covered preventive care services, such as annual wellness visits and mammograms for women.

Part B – Limits and Considerations 

Limits

Under Medicare Part B, there are annual limits on services for physical therapy, occupational therapy and speech language pathology.

Things to Consider 

  • Part B coverage can be used anywhere in the United States if you have Original Medicare and the physician accepts Medicare.
  • You can select any doctor in the United States who accepts Medicare patients.
  • Part B premiums and standard deductibles and cost sharing amounts generally change annually on January 1st.

Medicare Parts A and B – Enrollment

 

Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Parts A and B you can, if interested, select other coverage options (e.g. Medicare Advantage, Medigap, Part D, etc.) from approved private insurers. 

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When to Enroll
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When you are first eligible, your Initial Enrollment Period for Medicare Part A and Part B lasts seven months and starts when you qualify for Medicare, either based on your age or an eligible disability.
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FAQ Item Question
Individuals Aged 65 or Older
FAQ Item Answer

Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.

Enrollment Period

Example: If you are born on June 18, 1952, your Initial Enrollment Period is from March 1, 2017 until September 30, 2017.

FAQ Item Question
Individuals Aged Under 65 with an Eligible Disability
FAQ Item Answer

Your Initial Enrollment Period is based on when you began receiving Social Security or Railroad Retirement Board (RRB) disability benefits. It begins the 22nd month after you began receiving benefits and continues until the 28th month after you began receiving benefits.

Monthly Benefits

Example: If you began receiving disability benefits in January 2015, your Initial Enrollment Period is from November 1, 2016 until May 31, 2017.

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How to Enroll
Description
If you already receive Social Security or certain retirement benefits, you may be automatically enrolled in Original Medicare during this time period. Otherwise, you will need to sign up manually through the U.S. Social Security Administration.
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FAQ Item Question
Automatic Enrollment
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You will be automatically enrolled in Medicare Part A and Part B if you reach age 65 and receive Social Security or Railroad Retirement Board (RRB) retirement benefits. You will also be automatically enrolled if you are under age 65 with an eligible disability.

You will receive a Medicare card in the mail three months before your 65th birthday or your 25th month of disability. It will include instructions for opting out of enrollment for Part B, should you wish to do so.

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Manual Enrollment
FAQ Item Answer

You can apply for Medicare Part A and Part B under certain conditions:

  • You are eligible for Social Security or Railroad Retirement Board (RRB) benefits, but don’t receive them.
  • You qualify for Medicare due to End-Stage Renal Disease (ESRD).
  • You don’t qualify for premium-free Part A coverage.

Note: If you live in Puerto Rico and receive Social Security benefits, you will automatically be enrolled in Part A. However, you will need to apply for enrollment in Part B.

Choosing Other Medicare Coverage 

After you enroll in Medicare Parts A and B, you can choose a Medicare coverage option (such as a Medicare Advantage plan). You can change your coverage later, during the annual Open Enrollment Period. However, if you elect to receive Prescription Drug Coverage (Medicare D) coverage after your Initial Enrollment Period, a late enrollment penalty may be added to your insurance premium. Learn More

Late Enrollment and Changes to Medicare Coverage

Your Initial Enrollment Period provides a limited time window to enroll in Medicare Part A and Part B (Original Medicare). If you miss this enrollment period you can still enroll later, but you must manually apply for Medicare A and B, and some penalties may apply. There is no automatic enrollment outside of your Initial Enrollment Period.

Open Enrollment Period

October 15 through December 7

The Medicare Open Enrollment Period provides an annual opportunity to review, and if necessary, change your Medicare coverage. Below are some examples of changes that you can make during Open Enrollment: 

  • Join a Medicare Advantage (Part C) plan.
  • Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
  • Change from one Medicare Advantage plan to another.
  • Add or change your Prescription Drug Coverage (Part D) plan if you are in Original Medicare.
General Enrollment Period

January 1 through March 31

The General Enrollment period offers an annual opportunity to enroll in Medicare Part A and/or Part B. If you enroll in Medicare during the General Enrollment Period, your coverage starts July 1. For example, you can:

  • Sign up for Original Medicare if you weren’t automatically enrolled and missed your Initial Enrollment Period.
  • Enroll in Part B if you have opted out of automatic enrollment or dropped your coverage.

If you enroll in Part B after your Initial Enrollment Period, then you will spend more on your premium, unless you qualify for a Special Enrollment Period.

Special Enrollment Period

There are certain situations that may allow you to enroll in the Medicare program or Medicare options outside of the Initial and annual Open Enrollment Periods. 

If you have coverage through your employer and that coverage terminates, you may be eligible for a Special Enrollment Period. 

More information about Special Enrollment Periods is available on the Social Security website.