What is Original Medicare (Part A and B)?
Part A and Part B are often referred to as “Original Medicare.” Original Medicare is one of your health coverage choices as part of the Medicare Program. You will be in Original Medicare unless you choose a Medicare health plan. Original Medicare is managed by the Federal government. You can go to any doctor, supplier, hospital, or other facility that is enrolled in Medicare and accepting new Medicare patients. It is fee-for-service coverage, meaning that, generally, there is a cost for each service.
You generally pay a set amount for your health care (deductable) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. You usually pay a monthly premium for Part B.
What is Not Covered by Original Medicare?
Original Medicare doesn’t cover everything. If you need certain services that Medicare does not cover, you will have to pay out–of-pocket unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. Items and services that Medicare does not cover include, but are not limited to, cosmetic surgery, health care you get while traveling outside of the United States (except in limited cases), hearing aids and exams for fitting hearing aids, long-term care, most eyeglasses, routine dental care, dentures, and acupuncture. Generally, Original Medicare does not cover prescription drugs, although it does cover some drugs in limited cases such as immunosuppressive drugs (for transplant patients) and oral anti-cancer drugs. Some of these services not covered by Original Medicare may be covered by a Medicare Advantage Plan (like an HMO or PPO).
To find out if Medicare covers a service you need, visit WWW.MEDICARE.GOV, and select “Find Out What Medicare Covers,” or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
How Much Does Original Medicare Cost?
You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. For Part B, most people pay a standard monthly premium, but some people may pay a higher Part B premium based on their income.
The chart below shows the Part B monthly premium amounts for 2020 based on income. If you pay a late-enrollment penalty, this amount is higher.
|If your yearly income in 2018 (for what you pay in 2020) was||You pay each month (in 2020)|
|File Individual Tax Return||File Joint Tax Return||File Married & Separate Tax Return|
|$87,000 or Less||$174,000 or Less||$87,000 or Less||$144.60|
Up to $109,000
Up to $218,000
Up to $136,000
Up to 272,000
Up to $163,000
Up to $326,000
and less than
and less than
and less than
|$500,000 or Above||$750,000 and Above||$413,000 and Above||$491.60|