Original Medicare Coverage: What’s Included?

Most people understand that Medicare is federal health insurance coverage that you sign up for after you turn 65. What’s the difference between Medicare Advantage, Medicare Part D, Original Medicare and Medigap plans? When you enroll in Medicare, does that include all these different things, too? Not exactly. Keep reading to learn what is (and isn’t) included with Original Medicare once you sign up.

What Makes Someone Eligible for Medicare Enrollment?

Medicare is the name for America’s federal health insurance program that covers most people aged 65 and older. Younger people who become disabled and therefore cannot work may also qualify for Medicare, in certain circumstances. Anyone can enroll in Original Medicare up to three months before or after their 65^th birthday without paying any penalties.

Original Medicare Has 2 Different Parts

When people talk about Original Medicare, there are two specific components to that coverage:

1. Medicare Part A – Hospital insurance that covers the cost of inpatient stays, skilled nursing facility or hospice care, and some home health services. Anyone who pays Medicare payroll taxes while working at least 10 years can get premium-free Medicare Part A coverage. People who haven’t worked recently or enough years prior to turning 65 may pay monthly Part A premiums for coverage. Even with premium-free Medicare Part A, you still must pay any deductible, coinsurance, and copayment expenses for each benefit period.
   
2. Medicare Part B – Medical insurance that covers doctor’s visits, medical supplies, preventive check-ups/screenings, and outpatient care services. Anyone who signs up for Medicare Part B must pay a monthly premium for that coverage. You may pay a lifetime penalty if you don’t sign up for Part B during your initial Medicare enrollment period. That penalty raises your annual premium costs 10% for each year you delay Part B enrollment after turning 65.

What Isn’t Covered Under Original Medicare?

Original Medicare (Parts A and B) doesn’t include many services and items that private or employer-sponsored insurance plans normally cover. Some examples include:

• Vision (i.e., annual eyesight exams, prescription lenses, cataract surgery, contacts, etc.)
• Dental (i.e., preventive exams and cleanings, cancer screenings, fillings, crowns, bridges, dental appliances, oral surgery, etc.)
• Prescription medications (this also includes things like your annual flu shot, tetanus boosters, or other recommended vaccines as needed)
• Bills for any medical care you need while traveling outside the United States

In other words, Original Medicare won’t pay for your twice-yearly dentist’s visit. It also won’t pay for things like thyroid replacement hormones, blood-pressure pills or replacing a broken pair of prescription eyeglasses. Taking an anniversary trip to Mexico with your spouse? If you get food poisoning during your vacation, Original Medicare won’t pay for your IV fluids or antibiotics.

Want to ensure you have dental, vision or prescription medication coverage when signing up for Medicare? You must enroll in either Medicare Advantage (which includes Parts A, B and C), or purchase a Medigap supplement plan.