Original Medicare

Original Medicare

Generally, Medicare pays 100% of specific hospital costs and 80% of eligible physician and outpatient costs after annual deductibles are met. Most benefits have annual and lifetime limits, as well as copayments. Original Medicare does not pay for all your health care costs or outpatient prescription drug costs. Beneficiaries may choose a Medicare Advantage plan in lieu of Original Medicare, or supplement their Original Medicare by purchasing a Medicare Supplemental and/or a PDP plan. Confusing? Real facts can ease your mind, ___ click here for effortless enrollment.

MEDICARE DEDUCTIBLES

DO I PAY A DEDUCTIBLE?

Yes. Under Medicare you pay a deductible. Keep in mind that it may increase annually.

  • Part A Hospitalization. $1,316 per year.
  • Part B Physician and Outpatient services. $183 per year.
  • Part D Prescription Drugs. Varies by PDP plan and carrier.

IS IT TRUE, THERE ARE NO PREMIUMS FOR ORIGINAL MEDICARE?

Yes and no. While there aren’t any premiums for Part A (exceptions apply), premiums for Part B vary.

  • Part A. There is no premium for eligible Medicare Beneficiaries for Part A Medicare.A
  • Part B. There is a standard monthly premium of $134.00 for Part B Medicare for 2017. However, most beneficiaries who receive social security benefits pay less than this amount ($109 on average).
    • Beneficiaries whose annual income is greater than $85,000 pay a higher monthly premium based on a sliding scale. See chart below.

2015 Income vs. 2017 Payoff

Social Security can advise you the exact amount you’ll pay for Part B in 2017.

  • Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) 7 AM to 7 PM Monday-Friday for information.

MEDICARE ELIGIBILITY

AM I ELIGIBLE FOR MEDICARE?

Yes, if you are:

  1. Age 65 or older
  2. A U.S. citizen
  3. A permanent legal resident (for at least 5 years)
  4. An individual who has worked 40 quarters or more
  5. An individual who has worked less than 40 quarters may enroll in Part A (hospitalization) by paying a monthly premium, which is based on how many quarters worked. Contact 1-800-772-1213 for individualized information.A
  6. An individual who has paid Medicare taxes
  7. A permanently disabled individual under age 65 who has received Social Security disability benefits for at least two years automatically gets Medicare Part A and Medicare Part B.
  8. An individual who has end stage renal disease and other specific chronic illnesses automatically gets Medicare Part A and Part B benefits, effective the month disability benefits begin.A

ORIGINAL MEDICARE ENROLLMENT

HOW DO I A ENROLL IN MEDICARE PART A (hospitalization)?

Working individuals who turn age 65 are AUTOMATICALLY enrolled in Part A (hospitalization).

Other individuals may need to sign up for Part A MedicareA, as well as individuals who have worked less than 40 quarters.  These individuals should contact Social Security for individualized information.  See contact information below.

HOW DO I ENROLL IN MEDICARE PART B (doctors and other outpatient medical facilities)?

  • Some individuals are automatically enrolled in Medicare Part B, and some individuals need to sign up for Part B.
  • Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) 7 AM to 7 PM Monday-Friday.
  • http://www.ssa.gov
  • In person at a local Social Security office.
  • Railroad workers: Contact the Railroad Retirement Board (RRB) for enrollment information at 1-877-772-5772 (TTY 1-312-751-4701).

Part B premiums can be automatically deducted from your social security check, or you can choose direct quarterly billing.  Keep in mind that once you enroll, it takes several months for statements to arrive.

WHEN DO I ENROLL IN MEDICARE? 

  1. During your Initial Enrollment Period (IEP)

Eligible individuals can enroll three months before their birthday month, during their birthday month, or three months after their birthday month.  This is a seven-month enrollment period.  This enrollment period is for Medicare Part A and Part B and for Medicare Advantage (MA & MAPD) and Prescription Drug (PDP) coverage.

enroll-period-1075x118-new-note

E Working individuals age 65 or older, have different enrollment periods for Parts B and D if they are covered under an employer or union’s group plan. The enrollment period begins when a working individual, age 65 or older, retires or loses coverage, whichever occurs first.

  1. You can sign up for Part A and/or Part B during the Annual General Election Period. January 1 – March 31 of each year, if
    • You didn’t sign up when you were first eligible.
    • You aren’t eligible for a Special Enrollment Period (SEP).

Coverage will start July 1. Keep in mind if you enroll late in Part A and Part B, penalties may apply.

If you delay applying for Social Security or Railroad benefits beyond age 65, you have the option of enrolling in Medicare at age 65, and applying for social security retirement benefits later.

WHEN WILL MY MEDICARE COVERAGE START?

  • If you join during one of the three months before you turn 65, your coverage begins the first of the month you turn 65.
  • If you join during the month you turn 65, your coverage begins the first day of the month after you request enrollment in the plan.
  • If you enroll during one of the three months after you turn 65, your coverage begins the first day of the month after you request enrollment in the plan.
  • If you fail to enroll during your initial seven-month enrollment period, and enroll during the Annual General Enrollment Period (January 1 – March 31) your coverage begins the next July 1.

WHAT IF I ENROLL LATE IN PART B? (doctor/outpatient care)

If you enroll in Part B after your initial seven-month enrollment period, a late enrollment penalty of 10% for each full 12 months of your premium may be charged. This penalty continues as long as you are enrolled in Part B.

WHAT IF I ENROLL LATE IN PART D (prescription drug/PDP)?

If you enroll in Part D after your initial seven-month enrollment period, a late enrollment penalty of 1% per month of the national base beneficiary premium may be charged for each month your enrollment is late. This penalty continues as long as you are enrolled in Part D, and may increase in subsequent years.

WHAT IF I’M COVERED BY A UNION OR EMPLOYER’S GROUP PLAN?

There is no penalty for not enrolling in Part B or Part D coverage when you are initially eligible if you are enrolled in a union or employer’s group plan. In these situations, when you retire or your group coverage terminates (whichever occurs first), eligible beneficiaries are granted an eight-month Special Enrollment Period (SEP) to enroll in Part B without penalty. Part B enrollment will be effective the month after your employment ends or the month after you or your spouse’s group health insurance ends.

Likewise, when you retire or your group coverage terminates, whichever occurs first, eligible beneficiaries are granted a 63-day continuous Special Enrollment Period (SEP) to enroll in Part D without penalty.

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Part B – Doctors, Outpatient Surgery, other Medical Facilities, and Supplies.

Part D – Prescription Drugs

RECOMMENDATION/PART B and/or D

If you are covered by a union or employer’s planD when you are initially eligible for Medicare, contact your Human Resource Department to make certain that you have all the appropriate information to make an informed decision regarding enrollment.  You may or may not choose to waive Part B or D coverage while you are working.  It’s important to make certain your “group” prescription drug coverage is “creditable coverage” as well.  It may be wise to contact your employer’s insurance carrier too.  This is very important.

Note:  Different steps and enrollment periods apply to individuals enrolled in a COBRA or Retiree plan.


A Individuals who have worked less than 40 quarters can enroll in Medicare Part A.  The premium depends on how many quarters the individual has worked.  The average monthly premium for Part A coverage is $413.

B Premiums may increase.

C Reference insurance company’s literature for a complete list of preventive care benefits paid at 100%.

D Your or your spouse’s union or employer group plan.

E Different enrollment periods (Part B and D) apply for working individuals age 65 or older.

FIf your Medicare Supplemental enrollment application is submitted six months after your Initial Enrollment Period.