October 7th 2024
By Ari Parker
What is Original Medicare?
Learn everything you need to know about Original Medicare, also known as Traditional Medicare, including costs, coverage, and alternatives.
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October 7th 2024
By Ari Parker
Learn everything you need to know about Original Medicare, also known as Traditional Medicare, including costs, coverage, and alternatives.
Original Medicare is what you enroll in when you first get Medicare. Original Medicare is often also called Traditional Medicare or, sometimes, just “Medicare.” To enroll in any other type of Medicare coverage, you must first be enrolled in Original Medicare, which is made up of Medicare Part A and Medicare Part B. Original Medicare is run by the government, and your costs and coverage will be the same as everyone else. (In some cases, you may owe more or less if you have a particularly high or low income.)
In this guide, we’ll cover everything you need to know about Original Medicare, including:
What Original Medicare covers and how much it costs
When you can enroll in Medicare
The pros and cons of Original Medicare
How Original Medicare compares to other coverage options
Original Medicare covers a range of services to prevent illness, treat conditions, and maintain seniors’ health. It’s made up of Medicare Part A and Medicare Part B. Medicare Part A is generally considered your hospital insurance, and it covers inpatient care. Medicare Part B is considered your medical insurance for outpatient medical services and medical equipment. Below is a more detailed (but not comprehensive) list of what Parts A & B cover.
Part A covers:
Inpatient care in a hospital
Skilled nursing facility care
Inpatient nursing home care
Hospice care
Some home health care
Part B covers:
Doctor’s visits, consultations, and treatments
Outpatient care, including surgeries, diagnostic tests, X-rays, and lab work
Preventive services, such as screenings, vaccinations, and counseling services
Emergency ambulance transportation
Durable medical equipment, such as wheelchairs, walkers, and oxygen supplies
Medications administered in outpatient settings, such as chemotherapy drugs or injectable medications
Generally, if something is considered medically necessary, then it’s covered by Original Medicare. Below is a list of common services and equipment that are not covered by Original Medicare:
Prescription drugs
Dental care
Hearing services
Vision care
Long-term care
Cosmetic surgery
Physical exams (Medicare covers an annual “Wellness” visit)
Your monthly premiums are the amounts you pay to have Original Medicare coverage. Most people don’t pay a premium for Medicare Part A because they’ve worked and paid Medicare taxes for ten or more years. If you aren’t eligible for premium-free Part A, you’ll pay either $285 or $518, depending on how long you worked and paid Medicare taxes.
Most people pay a Part B premium of $185 in 2025. If your income is higher, you may also pay IRMAA (Income-Related Monthly Adjustment Amount). If you have a low income, you may be eligible for a Medicare Savings Program, which would reduce or eliminate your Original Medicare premiums.
Even with health insurance coverage, we often owe something out of pocket when we need care. Like all health insurance, Original Medicare has deductibles (there’s one for Part A and one for Part B). Medicare doesn’t start paying a portion of costs until you’ve met your deductible. In 2025, the Medicare Part A deductible is $1,676 and covers your share of costs for the first 60 days of each inpatient hospital benefit period. Note that the deductible is for each benefit period rather than for the year. The Part B deductible is an annual deductible of $257.
Once you’ve met your deductible, Medicare will start paying its share of the costs. At this point, Medicare foots the bill for 80% of costs, leaving you responsible for the remaining 20%. (Some services, like vaccines, may be 100% covered, meaning you won’t owe anything.)
While some people are eligible for Medicare because they have certain disabilities or conditions, most people become eligible for Medicare due to age. If you age into Medicare, you’re eligible to enroll in Original Medicare during a seven-month period that surrounds your 65th birthday—this is called your Initial Enrollment Period (IEP). Your IEP begins three months before the month you turn 65 and ends three months after.
If you’re already drawing from Social Security, then you’ll be automatically enrolled in Medicare. Otherwise, you’ll have to apply to enroll in Medicare. To do so, contact Social Security during your IEP.
Once you enroll, you will receive a red, white, and blue Medicare card in the mail. If you didn’t receive your card and are unsure if you’re enrolled, you can view your status online via your Medicare account or Social Security account.
54% of Medicare beneficiaries choose to switch from Original Medicare to Medicare Advantage—the other 46% are on Original Medicare. With almost a 50/50 split, it’s important to understand the pros and cons of Original Medicare so you can make an informed decision about your health insurance coverage.
Put simply, Original Medicare makes getting the care you need easy. Unlike private health insurance plans (including Medicare Advantage), Original Medicare doesn’t have provider networks, doesn’t require prior authorization, and doesn’t require referrals to see specialists. If you’re on Original Medicare, you’re also able to add a Medicare Supplement plan to your coverage, which significantly reduces your out-of-pocket costs.
No health insurance is perfect, and on its own, Original Medicare is missing some key elements. It notably doesn’t cover prescriptions. It also doesn’t cover dental, vision, and hearing services. Finally, it doesn’t have a maximum out-of-pocket amount that will limit your total healthcare costs in a year. This means that, without a Medicare Supplement plan, if you receive $100,000 in care for a year, you’ll owe $20,000 out of pocket for those services.
Once you’re enrolled in Medicare, you are able to switch to Medicare Advantage or stack additional coverage onto your Original Medicare coverage. A little over 50% of Medicare enrollees choose to enroll in a Medicare Advantage plan. Below, we’ll explain the other Medicare coverage options and explain how they compare to Original Medicare.
Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare. If you choose to enroll in a Medicare Advantage plan, you cannot be enrolled in Original Medicare at the same time. Switching between Original Medicare and Medicare Advantage is easy, and you can make a change every year during Medicare’s Open Enrollment Period.
Nationwide, more people are choosing Medicare Advantage over Original Medicare, but a lot of people are also leaving Medicare Advantage plans. Ultimately, understanding the pros and cons of Medicare Advantage is the most important thing to avoid a Medicare Advantage nightmare. In a nutshell, Original Medicare provides you with better access to care and, when paired with a Medicare Supplement plan, it provides fantastic coverage and predictable healthcare costs. Medicare Advantage plans provide extra benefits, like prescription coverage and dental vision and hearing services. Medicare Advantage plans also come with a maximum out-of-pocket amount, which limits how much you'll spend on healthcare in a year. Learn more about the pros and cons of Medicare Advantage and Original Medicare here.
Unlike Medicare Advantage, Medicare Supplement plans aren’t an alternative to Original Medicare. Instead, Medicare Supplement plans (also commonly called Medigap plans) stack on top of your Original Medicare coverage.
Remember how, with Original Medicare, you’re responsible for 20% of the cost of services? Medicare Supplement plans reduce out-of-pocket costs, in some cases virtually eliminating them. Each of the ten standard Medigap plans pays for certain out-of-pocket costs, including deductibles, coinsurance, and copays.
Original Medicare and Medicare Part D are completely separate, but work together to provide Medicare enrollees with the coverage they need. Original Medicare does not cover prescriptions, which is why the government introduced Medicare Part D (prescription drug coverage). If you’re on Original Medicare, it’s generally a good idea to also get a separate Part D plan to get your prescriptions covered.
If you don’t currently take any prescriptions, you may be tempted to skip Part D enrollment—but beware! If you don’t enroll in Medicare Part D when you first enroll in Medicare, you may be subject to a Part D late enrollment penalty later on. For this reason, we generally recommend that people who don’t have any or many prescriptions enroll in a low-cost Part D plan.
Comparing your Medicare options can feel overwhelming. From Original Medicare vs Medicare Advantage to the different plans available through Medicare Advantage, Medicare Supplement, and Medicare Part D, there’s a lot to look at!
Unfortunately, there’s not one best Medicare health plan for everyone. What works best for you will depend on your unique health and financial situation. That’s why we recommend working with one of our licensed Medicare agents. Your agent will help you understand your different options, compare your costs among the different Medicare health plans, and enroll in a plan that saves you the most. Ready to get Medicare out of the way today? Give us a call at (855) 900-2427 or schedule a time to talk.
