Medicare 101: What is Original Medicare?

Your ultimate beginner’s guide to Parts A & B.

Medicare Part A

(Inpatient Hospital/Hospice Insurance)

What is it?

Providing coverage for inpatient hospital stays, hospice care, and some skilled nursing care, Medicare Part A makes up half of what’s called “Original Medicare” (Medicare Parts A and B). 

Medicare Part A is funded by the federal government and is run by both state and federal agencies. 

What does it cover?

Medicare Part A covers four main areas of inpatient care. 

1. Inpatient hospital visits:

Inpatient medical or surgical treatment

Semi-private rooms

Nursing services

Drugs and medications that are part of your inpatient treatment

Hospital meals

Mental health care

Participation in qualifying clinical research studies or demonstrations

2. Nursing home care:

Semi-private rooms

Medically necessary rehabilitation services

Meals

Dietary counseling

Medical social services

 

3. Home health services:

Physical or occupational therapy

Part-time skilled nursing care

Durable medical equipment ordered by your doctor

Home health aide services

Medical social services

Speech-language pathology services

4. Hospice care:

Necessary medical treatment to decrease symptoms or ease suffering

Nursing care

Pain management services

Pain relief medications

Medical supplies

Durable medical equipment

Social services

Hospice aide services

Housekeeping services

Physical or occupational therapy

Meals

Dietary counseling

Short-term respite care

Who is eligible?

You’re eligible for Medicare Part A benefits if one or more of the following situations applies to you:

  • You’re 65 years or older and are a US citizen or have been a US permanent legal resident for at least five years in a row
  • You’re eligible for retirement benefits
  • You’re currently receiving government disability benefits
  • You suffer from end-stage renal disease (also known as catastrophic kidney failure or ESRD)
  • You suffer from amyotrophic lateral sclerosis (also called Lou Gehrig’s disease or ALS)

Medicare Part B

(Outpatient Medical Insurance)

 

What is it?

Making up the other half of “Original Medicare,” Medicare Part B offers coverage for both routine and urgent outpatient medical care.

Like Medicare Part A, Medicare Part B is also funded by the federal government and run by both federal and state government agencies.

What does it cover?

Medicare Part B covers two main areas of outpatient care:

  • Medically necessary services

This includes any outpatient health care service or supply, such as a visit to the doctor’s office, that you may need to treat or diagnose an illness or injury.

  • Preventative care

This includes any health care service or supply that you may need to help prevent an illness or injury or detect it early on when treatment will be more effective. Some examples include:

  • Outpatient doctor’s visits and surgeries
  • Ambulance services
  • Clinical research studies
  • Mental health services
  • Limited outpatient prescription drugs

 

Who is eligible?

If you’re eligible for Medicare Part A, chances are you’re already eligible to enroll in Medicare Part B benefits. Typically, to enroll you must be:

  • 65 years old or older
  • A US citizen or legal permanent resident who has been living in the US for at least 
five years in a row

Or if you are under 65 years old, you may qualify for enrollment if one of the following applies to you:

Note: You will be automatically enrolled in Medicare Part B benefits only after 24 consecutive months of receiving Social Security or RRB disability benefits.

 

Remember: if you need extra help deciding which plan you should enroll in, you can always talk to a licensed Medicare agent for free, with no commitment required on your part. Just call 833-716-0673 today for help.

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