Original Medicare Coverage

Medicare Part A and Part B are often called “Original Medicare.” This coverage is managed by the federal government, and generally, there is a cost for each service.

Part A – Hospital Insurance

Medicare Part A helps cover inpatient care in hospitals, as well as some home health care, stays in skilled nursing facilities, and hospice care expenses.

Part A does not cover all of your costs, and you must pay a deductible before Medicare pays for any of your expenses. The Part A deductible for 2013 is $1,184.

Most people get Part A coverage at no charge because they paid Medicare taxes while working. This is called “premium-free Part A” and you get it at age 65 if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible but have not filed to get Social Security or Railroad benefits.
  • You or your spouse had Medicare-covered government employment.

If you are younger than age 65, you can get premium-free Part A if:

  • You received Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have end-stage renal disease and meet certain requirements.

If you don’t qualify for premium-free Part A, you must pay a premium for coverage. If you buy Part A, you will pay $441 each month in 2013.

Part B – Medical Insurance

Medicare Part B helps cover eligible doctor and other health care provider services, outpatient care, home health care, and other eligible services. It also helps cover some preventive services that help keep you healthy. You pay nothing for most preventive services if you get them from a health care provider that accepts assignment.

Examples of Part B Eligible Expenses:

  • Doctor’s visits, lab tests, and surgery
  • Mammograms, prostate cancer screenings, and other preventive services
  • Flu shots and certain immunizations
  • Physical therapy (limited visits per year)
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health services
  • Getting a second opinion
  • Clinical research

You must actively enroll in Part B and pay a premium each month. The monthly premium for 2013 is $104.90 for most people, depending on income (higher income earners may pay more). The amount you pay depends on the income reported on your tax statement from two years ago.

Everyone who has Part B coverage pays an annual deductible. The deductible is $147 for 2013. Part B generally covers 80 percent of the cost for medically necessary services, but this amount can vary depending on the services you receive. You may also be required to pay co-insurance or co-payment amounts.

Helpful Tips

Medicare doesn’t cover all of your expenses, so put these tips to use:

  • Learn what Medicare covers and what it doesn’t. Your doctor or another health care provider can help you find out if Medicare covers certain services and supplies. You can also search online.
  • If Medicare does not cover the expense, be aware that you may be asked to read and sign a notice that states you may have to pay out of your pocket for the services or supplies.
  • Know your co-insurance and co-payment fees. Find detailed cost information on the Medicare website.
  • Decide if you need other insurance or a Medicare plan to help cover your eligible expenses. For example, you may want to purchase a dental plan.
    • We can help you get coverage. Give us a call at 1-877-470-3108, TTY 711, or visit our Find Coverage page to get started.


Medicare has neither reviewed nor endorsed this information.