Medicare Part A & B
Key Takeaways
- Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). is federally administered insurance for individuals who are 65 years of age and older or who have certain disabilities.
- Original Medicare has two parts: Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare. is hospital insurance, and Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. is medical insurance.
- People on Medicare can see any doctor in the country who accepts Medicare.
- You have a seven-month window when you turn 65 called your Initial Enrollment Period (IEP)The Initial Enrollment Period (IEP) is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. to enroll in Original Medicare — the month of your birthday plus three months before and after your birthday month. If you miss your IEP, you’ll need to wait for the Annual Enrollment Period or qualify for a Special Enrollment Period.
What Is Medicare?
With more than 60 million Medicare enrollees in the country, if you’re an adult in the U.S. chances are that you either receive Medicare benefits or know someone who does. If you or a loved one will soon be eligibleSome health plans require you to meet minimum requirements before you can enroll. for Medicare, we have answers to your questions.
Medicare: The Basics
Medicare is public health insurance for adults who:
- Are 65 years of age or older.
- Are younger than 65 years of age but have qualifying disabilitiesA disability is a restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being. The Social Security Administration judges disability — and whether you qualify for financial assistance — based on whether you can work. .
- Are U.S. citizens or permanent residents.
Administered by the Centers for Medicare & Medicaid Services (CMS), Medicare receives funding through the federal budget, income taxes paid to Social Security and Medicare, and premiums paid by Medicare beneficiaries. Original Medicare (Part A and Part B) insurance can be used at any doctor’s office or hospital in the U.S. that accepts it.
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What’s Covered by Medicare?
Medicare Part A and Medicare Part B cover most standard healthcare services. Part A is hospital insurance, covering inpatient care you receive in hospitals and other facilities. Part B is medical insurance, which covers doctor’s office visits and other outpatient care.
Part A
Hospital Insurance
- Inpatient
- Skilled nursing facility care
- Hospice care
- Home health care
Part B
Medical Insurance
- Doctors & other care providers
- Outpatient care
- Home health care
- Medical equipment (like walkers, wheelchairs, or beds)
- Preventive & screening services
Between Parts A and B, Original Medicare helps pay for a wide range of essential services. To pay the costs Original Medicare doesn’t cover, you may consider adding a Medicare Supplement Insurance (Medigap) plan from a private insurance carrier. You also have the option to switch to a privately administered Medicare Advantage plan, which substitutes for Original Medicare and may include additional benefits.
How Much Do Medicare Part A and B Cost?
Medicare can help you save on healthcare costs, but it isn’t free. Here are some of the expenses you should consider as you plan your budget:
Medicare Part A costs for 2025
- Deductible: $1,676
- Premium: $0 (for most people)
- Medicare Part A daily coinsurance for hospital stays after meeting deductible:
– Days 0-60: $0
– Days 61-90: $419 per day
– Lifetime Reserve Days: $838 per day
Keep in mind:
- Most people don’t pay a Part A premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. as long as they or a spouse worked and paid taxes for a certain length of time, usually about 10 years.
- You’ll be responsible for meeting your Part A deductibleA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. before insurance starts to pay.
Medicare Part B costs for 2025
- Deductible: $257
- Premium: $185
- After meeting your deductible, you will pay about 20% of the cost of most care in coinsurance.
Keep in mind:
- Medicare Part B has a standard yearly deductible you must meet before insurance starts to pay.
- Medicare Part B has a standard monthly premium, but people with higher incomes pay more.
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How Do I Get Original Medicare?
How do you enroll in Original Medicare? Most Americans are automatically enrolled in Part A when they reach 65 years of age.
You must contact the Social Security Administration to enroll in Part B if you’re already enrolled in Part A. You can enroll online if you actively sign up for both Parts A and B at the same time.
Because you pay a premium for Part B coverage, you can turn down the coverage. If you turn down Part B coverage during your Initial Enrollment Period but choose to join later, you may be charged a late enrollment penalty and have to pay a higher monthly premium.
When Can I Add Part D Coverage?
To cover the costs of most medications, you will need a Medicare Part D prescription drug plan:
- Part D is an optional Medicare benefit that helps you pay for any prescription medications you currently use or will need in the future.
- Private health insurance companies administer Part D. The federal government sets specific requirements, but private health insurance companies set costs and decide which drugs to cover.
When Am I Eligible to Enroll in Medicare?
The majority of Americans enroll in Medicare health insurance around the time they turn 65 years old. Remember the seven-month rule, which says that you have seven months to enroll in Medicare during the year you turn 65.
For example, if you turn 65 in August:
- Three months before your birth month: May, June, July
- Your birth month: August
- Three months after your birth month: September, October, November
If your birthday is on the first of the month, your enrollment period starts four full months before you turn 65. The period ends two months after the month when you turn 65.
You’re eligible for Medicare if you’re an American citizen or a resident who has lived in the U.S. legally for five or more years, and if any of the following apply to you:
- You’re 65 years of age or older.
- You’ve received Social Security disability benefits for more than 24 consecutive months.
- You’ve received disability benefits from the Railroad Retirement Board for more than 24 consecutive months.
- You have kidney failure, also known as end-stage renal disease, requiring permanent dialysis or need a kidney transplant.
- You’re living with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Can I bundle multiple benefits into one plan?
Is Medicare the Right Choice for You?
Here’s a recap of Original Medicare, its costs, how to enroll, and what it covers:
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- If you want prescription drug coverage, you can join a separate Part D plan from a private health insurance carrier.
- To help pay your out-of-pocket costs in Original Medicare (like 20% coinsurance), you can also explore Medicare Supplement coverage.
- You can use any doctor or hospital that accepts Medicare, anywhere in the U.S.
Another option is a Medicare Advantage plan. We recommend you also take time to learn about both Medicare Advantage and Medigap, comparing what you can expect to pay in premiums and out-of-pocket costs.
Contact a GoHealth licensed insurance agent to discuss your options and get answers to your questions.
FAQ
Do I sign up for Medicare online?
To enroll, you will need some basic information:
- Name
- Address
- Phone number
- Social Security number
- Identification documents, such as a birth certificate, driver’s license, or proof of U.S. citizenship.
Do I need Medicare If I’m still working and have health insurance?
If your company has less than 20 employees receiving health insurance, then you should enroll in Medicare as your primary insurance. Your employer can pay less or nothing for your care in this instance.
Since most people pay no monthly premium for Medicare Part A, it’s likely a good idea to enroll when you turn 65, even if you’re waiting to enroll in Part B. If you need to be hospitalized, Part A may help with costs not covered by your employer-provided insurance.
Can I switch from Original Medicare to a Medicare Advantage plan?
Between January 1 and March 31 each year, anyone with a Medicare Advantage plan can elect to leave and return to Original Medicare, or you can switch to a different Medicare Advantage plan.
You may also qualify for Special Enrollment Periods during other times of the year.
Contact a licensed insurance agent to discuss your options and find a Medicare Advantage plan that fits your needs.
Can I use a Health Savings Account with Medicare?
Sources
- Fast Facts. CMS.gov.
- Medicare costs at a glance. Medicare.gov.
- Medicare Benefits. SSA.gov
- How Medicare Works With Other Insurance. Medicare.gov
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.