What is Original Medicare?

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People who pay a Part A premium (most don’t) could pay an additional 10% of the premium amount. The penalty is charged every month for twice the number of years enrollment was delayed.

You could pay an additional 10% of the premium amount for each full 12-month period enrollment is delayed. The penalty is charged every month for as long as you have Part B.

You could pay an additional 1% of the average Part D premium for each month you delay enrollment. The penalty is charged every month for as long as you’re enrolled in Part D.

• Age: 65 and older
• Disability: Under 65 and receiving
• Social Security Disability Insurance (SSDI) payments for more than 24 months
• Illness: Any age with end stage renal disease or ALS
• Residency: U.S. citizen or permanent resident for five consecutive years

• If you already have Social Security when you turn 65: You will be automatically enrolled in Medicare. You will receive your Medicare card three months prior to your birthday.
• If you do not have Socail Security when you turn 65 you will need to sign up for Medicare
• Three Ways to Join Medicare:
  • You can apply online at: www.ssa.gov
  • Call Social Security at: 1-800-772-1213 (TTY 1-800- 325-0778) to apply over the phone or to request an application
  • • Apply at your local Social Security office

Original Medicare is Part A and Part B

Part A is Hospital Insurance and provides some coverage for:

• Inpatient hospital care
• Skilled nursing facilities
• Hospice care
• Limited home healthcare

This is not a complete list of services available.

Part B is Medical insurance and provides some coverage for:

• Doctor visits and preventative services
• Outpatient surgery
• Diagnostic screenings
• Emergency care
• Durable medical equipment

This is not a complete list of services available.

• Deductibles
• Copays/Coinsurance
• Outpatient Prescription Drugs
• Healthcare outside the U.S.
• Hearing Aides, Exams, Screenings
• Routine Eye Exams and Most  Glasses

Original Medicare generally covers 80% of your Hospital and Medical expenses.

Part A - usually no premium if you are Eligible and paid into Social Security for 40 quarters. If you don't qualify on your own, you may be eligible on your spouse's work history when you turn 65.

Part B - The standard premium in 2025 is $185.00/month but could be more based on your income from tax returns two years prior. 

Part A late penalty - If you don't qualify for premium-free Part A, you may have to pay a late enrollment penalty if you don't enroll in Part A during your seven-month initial enrollment period, which starts three months before the month you turn 65 and ends three months after your birthday month.

Part B late penalty - If you do not sign up for Part B when first eligible and you are not covered by other credible medical insurance you may incur a late enrollment penalty for as long as you have Part B.

Part D penalty - If you do not sign up for Part D when first eligible and you did not have creditable coverage for more than 63 days, you may have to pay a late enrollment penalty for as long as you have Part D.

Part D provides outpatient prescription drug coverage for some prescription drug costs. 

Note that Original Medicare does not include outpatient prescription drug coverage.

Two ways to obtain Part D coverage:

1. Stand alone prescription durg plan
2. With an integrated Medicare Advantage plan

Additional help paying for prescriptions may be available. You may qualify for a Low-Income Subsidy (LIS) if your yearly income and resources are below certain limits.

You can apply at: www.ssa.gov/benefits/medicare/prescriptionhelp/

Part C combines Parts A and B and can include Part D, known as Medicare Advantage Plans. 

• Advantage plans are offered by private insurance companies with an approved Medicare contract and may offer value-added benefits

Supplements can fill some of the GAPS original Medicare does not cover. Often referred to as MEDIGAP Insurance.

• Purchased from private insurance companies
• Can cover deductibles, copays, and coinsurance
• Freedom to choose any Medicare-appointed doctor in the U.S.
• Has a monthly premium and can vary based on state, county, and zip code
• Supplements DO NOT cover presciption drugs

There is a lot to know about Medicare, which means you may have a lot of questions.

• How and when do I start Medicare?
• I'm still working, do I have to take Medicare now?
• How do I avoid the penalties?
• What are my options in Idaho?
• What is a Supplement (Medigap) vs. Advantage plan?
• How do I make sure my prescription drugs are covered?
• How do I choose a plan?

Everyone's healthcare needs are different. That's why it's nice to have 1-on-1 support from a local experienced independent agent. 

When we meet, you will learn about Original Medicare through the federal government, and about your other options for Supplemental coverage and prescription drug coverage. 

You will learn the difference between Medicare Advantage (Part C) and MEDIGAP Supplement plans. You will know more about prescription drug coverage. 

We will provide you the knowledge and information necessary to make an informed decision that best meets your healthcare needs.

It depends on how you get your health insurance now and the number of employees that are in your company where you (or your spouse) work.

Generally, if you have job-based health insurance through your (or your spouse's) current job, you don't have to sign up for Medicare while you (or your spouse) are still working. You can wait to sign up until you stop working or lose your health insurance (whichever comes first).

• Ask your insurance provider if your coverage is an employer group health plan as defined by the IRS. If it's not, sign up for Medicare when you turn 65 to avoid Part B late enrollment penalty.

• You might need to sign up for Medicare when you turn 65 so you don't have gaps in your job-based health insurance. Check with the employer.

• Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. COBRA and VA coverage are not considered creditable coverage by Medicare. This could lead to a lifetime late enrollment penalty.