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Medicare Part A and Part B

Medicare Part A and Part B, also known as Original Medicare, is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card. Original Medicare pays for many health care services and supplies, but it doesn't pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called "gaps" in Medicare coverage.
Eligibility and Enrollment

Medicare is a Health Insurance Program for:

  • People 65 years of age and older
  • Some people with disabilities under age 65
  • People with End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Most people get Part A automatically when they turn age 65. They do not have to pay a monthly payment, called a premium, for Part A because they or a spouse paid Medicare taxes while they were working. If you (or your spouse) did not pay Medicare taxes while you worked and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show "Hospital Part A" on the lower left corner of the card.

Enrolling in Part B is your choice. You can sign up for Part B any time during a 7-month period that begins 3 months before you turn 65, or when you become Medicare eligible. Call the Social Security Administration at 1-800-772-1213 or visit or call your local Social Security office to sign up. If you choose to have Part B, you pay the Medicare Part B premium of $96.40 per month.

If you don't enroll in Medicare Part B when you are first eligible or after you drop employer coverage, you may have to pay a higher monthly premium for Medicare Part B. You will have to pay this extra amount as long as you have Medicare Part B. There are three times when you can enroll in Medicare Part B.

These are called your:

  1. Initial Enrollment Period-Starts three months before the month you turn age 65 and ends three months after the month you turn age 65.
  2. General Enrollment Period-This period runs from January 1 through March 31 of each year. Your coverage will start on July 1 of the year you sign up.
  3. Special Enrollment Period-A time when you may enroll, if you meet certain conditions (for example, your group health plan coverage ends).

Coverage

Part A is hospital insurance. It helps pay for care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care.

Part B is medical insurance. It helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

H3957_H3916_S5593_12_0823 CMS Approved This page last updated 1/18/2013

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The information contained on this website regarding the Patient Protection and Affordable Care Act of 2010 (“PPACA”), as amended, and/or any other law, does not constitute legal or tax advice and is subject to change based upon the issuance of new guidance and/or change in laws.

The information provided is intended to provide general information only and does not attempt to give you advice that relates to your specific circumstances. State laws and regulations governing health insurance and health plans may vary from state to state. Further, any information regarding any health plan will be subject to the terms of its particular health plan benefit agreement and some health plans may not be available in every region or state.

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