Original Medicare

Original Medicare (Part A & B)

  • Covers many, but not all medical expenses
  • Required to have Original Medicare and Part D coverage
  • There is a 7-month window to enroll
    • 3 months before your 65th birth month
    • The month of your 65th Birthday
    • 3 months after your 65th birth month

Heres what you can expect your medicare card to look like!

Original Medicare Penalties

Part A

  • Not paying into FICA for 10 Years will result in a Lifetime penalty added to your premiums
    • If you paid 10+ years towards FICA No Penalty will be added and you will have a $0 premium

Part B

  • Delayed initial enrollment after turning 65 will result in a LIFETIME 10% penalty for each year you could have signed up for Medicare part B, but did not.
    • Initial enrollment runs for 7 months (3 months before your 65th birthday, the month of your 65th birthday, and 3 months following your 65th birthday)

Medicare Part A (Hospital Only)

What’s Covered?

  • Semi-private rooms
  • Meals
  • General nursing
  • Drugs administered in the hospital (including methadone to treat an opioid use disorder)
  • Other hospital services and supplies as part of your inpatient treatment (i.e x-rays, MRIs

Inpatient Stay

*** Lifetime Reserve is 60 additional inpatient days that Medicare will pay for when you’re in the hospital for more than 90 days at one time. ***

Skilled Nursing Facility (SNF)

  • You must have a medically necessary inpatient stay for 3 days in order to qualify for a skilled nursing facility
    • Discharge day does not qualify for one of the inpatient days
  • A condition that started while you were getting care in the SNF for a hospital-related medical condition
    • If you develop an infection that requires IV antibiotics while you’re getting SNF care

*** There is no lifetime reserve for skilled nursing ***

Medicare Part B (Medical)

What’s Covered?

  • Ambulance services
  • Clinical Research
  • Durable Medical equipment (DME)
    • Oxygen equipment & accessories
  • Limited outpatient prescription drugs
  • Mental Health & substance use disorders

What’s NOT Covered?

  • Routine eye exams (glasses and contacts)
  • Hearing aids
  • Dental benefits
  • Cosmetic surgery
  • Massage therapy
  • Annual routine physical exams (Blood work)
    • Initial preventive physical exam (IPPE)
    • Extensive Wellness visit (AWV)
  • Nursing Room Care (Long Term Care)

Premiums

  • Your monthly Part B Premium is based on your Modified Adjusted Gross Income (MAGI) from 2 years ago
  • Higher Income = Increased monthly premiums
    • Standard Premium = 185.00 (2025)

Medicare Part D (Prescription Drug Coverage)

  • Federal Government requires members to have minimal drug coverage!
  • May purchase a Stand-Alone Drug Plan (PDP) or get Medicare Advantage Plans (MAPD) which includes a prescription drug plans

Prescription Drug Plans:

  • Have specific lists of covered drugs
  • Are sold by private insurance companies
  • Can have monthly premiums
  • Co-Insurance Tiered co-pays
Medicare Supplement vs. Advantage