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Medicare Overview

Original Medicare Eligibility And Insurance Programs

The original Medicare is also referred to as Medicare Fee For Service.


Medicare is available to U.S. citizens and lawful residents:
The Original Medicare covered services, administered by the federal government through the Center for Medicare and Medicaid Services (CMS), includes two related health insurance programs, Medicare Part A and Medicare Part B.

Medicare Part A
(Hospital Insurance) Helps Cover

Medicare Part B
(Medical Insurance) Helps Cover

"To qualify for home health care benefits under either Part A or Part B, a beneficiary must be confined to his/her home, under the care of a physician, and in need of skilled nursing services on an intermittent basis, physical therapy, or speech-language pathology services"

Original Medicare Premium And Cost Sharing

Part A Premium

Most people don’t pay a premium for Part A because they or a spouse, typically, already qualified for premium-free coverage through their payroll tax contribution over at least 40 quarters of coverage, while working.

Typically, you have free Part A if you are age 65 or more, and eligible for monthly Social Security or Railroad Retirement Board (RRB) retirement benefits.

If you don’t qualify for premium free Part A coverage, you can get Part A coverage by paying a monthly premium, provided you are a U.S. citizen or lawful permanent resident with 5 years of continuous residency in the U.S. prior to the month of filing an application for Medicare.

For 2024:

In addition to paying the Part A premium, in most cases you must also enroll in Part B and pay the Part B premium. You can buy Part B only, without Part A.

Part A Deductible and Coinsurance

For the calendar year 2024, for each benefit period, you have a projected deductible amount of $1,632 ($1,600 in 2023)and coinsurance as follows:

For Skill Nursing Facility (SNF) stay you pay for each benefit period:

A benefit period begins the first day an enrollee is admitted to a hospital or received extended care services, and it ends when the enrollee has not been an inpatient of a hospital or other facilities for 60 consecutive days

Part B Premium

For CY 2024, the projected standard Part B monthly premium amount is $174.70 ($164.90 in 2023) or higher, depending on your Modified Adjusted Gross Income (MAGI) filed with IRS in 2022. This corresponds to about 25% of the full premium, and the remaining is paid by the federal government.

The premium then increases by income bracket to 35%, 50%, 65%, 80%, and 85% of the full premium. According to CMS, about 8% of the beneficiaries with Part B are affected by the premium adjustment known as Income Related Monthly Adjustment Amount (IRMAA). 

Part B Deductible

The calendar year 2024 Part B deductible is $240 ($226 in 2023). After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (DME)

Private Insurance Options

The following coverages are provided through private health insurance companies

Enrollment Options

You have the option to enroll in the Original Medicare or in a Medicare Advantage Plan. If you decide to enroll in the Original Medicare, you need to know:

Enrollment Periods

You Can Enroll In Medicare During The Following Periods:

The OEP is sometimes referred to by CMS as General Enrollment Period (GEP).

Late Enrollment Penalty

Part A Late Enrollment Penalty

If you are not eligible for premium-free Part A, and you do not buy it when you are first eligible, your monthly premium may go up 10%. You will have to pay the higher premium for twice the number of years you could have had Part A but did not sign up.

Part B Late Enrollment Penalty

If you do not sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly Part B premium may go up 10% for each 12 month-period that you could have had Part B but didn’t sign up. If you are allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty.