Medicare Advantage FAQs

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Health Insurance

What is Original Medicare?

Original Medicare is health coverage offered by the federal government. It is overseen by the Centers for Medicare and Medicaid Services, commonly known as CMS.

With Original Medicare, you can see any doctor nationwide that accepts Medicare, but you will have out-of-pocket costs that are usually 20% of the cost of Medicare-approved services, after you meet your deductible. This is called coinsurance. Medicare covers the remaining 80%.

Original Medicare includes:

  • Part A, which provides hospital coverage
  • Part B, which provides coverage for outpatient medical services, such as your doctor’s visits

Original Medicare also does not include coverage for your prescription drugs, so you would need to purchase a stand-alone prescription drug plan to supplement Original Medicare.

What is Medicare Part A?

Medicare Part A is coverage for care received in the hospital.

Most people are automatically enrolled when they turn 65…as long as they are getting Social Security benefits at least 4 months prior to turning age 65. Having said that, most are eligible to enroll 3 months before the month they turn 65. This eligibility period lasts for the 3 months following the month of their 65th birthday. For example: If you turn 65 on May 15th, you would be eligible to enroll anytime between Feb 1 and August 31 of that year. You also have a time each year when you can change your plan. This is called the annual election period, or AEP, and runs Oct 15 – Dec 7. Finally, most people do not pay a premium as they have already paid for it through payroll deductions.

What is Medicare Part B?

Part B is coverage for medical services, such as doctor’s visits and outpatient care.

Like Part A, most people are eligible to enroll 3 months before the month they turn 65. This eligibility period lasts for the 3 months following the month of their 65th birthday. For example: If you turn 65 on May 15th, you would be eligible to enroll anytime between Feb 1 and August 31 of that year. With Original Medicare, there are enrollment periods to pay attention to, or you could pay penalties. You also have a time each year when you can change your plan. This is called the annual election period, or AEP, and runs Oct 15 – Dec 7.

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