Original Medicare

You will be automatically enrolled in Original Medicare Part A & Part B when you are eligible and start receiving your Social Security benefits. It may not be the best Medicare healthcare plan available to you. Original Medicare can leave you at greater financial risk

and with higher costs for benefits not covered by Original Medicare.

Pros

  • See any doctor, anywhere, who accepts Medicare.

  • Not restricted to healthcare network. (IASIS, Mountain Star, Intermountain Healthcare or University Of Utah)

Cons

  • You are are responsible for 20% of your medical costs.

  • No limit on your 20% total annual out-of-pocket costs.

  • You are own your own to deal with Medicare. No licensed, local agent to assist you when dealing with Medicare claims & coverage issues.

  • Prescription drugs, vision, hearing, and dental not included.

Frequently Asked Medicare Questions:

What Is Medicare?

Medicare is...

  • A federal health insurance program for eligible U.S. citizens and legal residents

  • Funded in part by taxes you pay while working

  • Individual health insurance

 

Medicare is not...

   • A family health plan • Social Security
   • Medicaid
   • Free

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Who Can Get Medicare?

U.S. citizens and legal residents

Legal residents must live in the U.S. for at least 5 years in a row,

including the 5 years just before applying for Medicare.

 

You must also meet one of the following requirements:

• Age 65 or older

• Younger than 65 with a qualifying

   disability

• Any age with a diagnosis of end-stage

  renal disease or ALS

 

What Does Medicare Cover?

Original Medicare = Parts A & B

   

   • Part A is hospital insurance covering

     inpatient hospital and skilled nursing

     care

   • Part B is medical insurance covering doctor visits and

     outpatient care

   * Original Medicare does NOT include Part D (Prescription Drug Coverage)

      You can enroll in that separately.

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What are my Options?

You can add coverage to Original Medicare or choose a Medicare Advantage Plan

You may add a standalone Part D plan, a Medicare supplement plan or

both to Original Medicare (Parts A and B.)

 

Medicare Advantage

You may choose to get your benefits through a Medicare Advantage Plan ( Part C.) Many plans come with built-in prescription drug coverage. You can add a standalone Part D plan only with certain Medicare Advantage plans. 

 

What Does Medicare Cost?

2021 Original Medicare Part A (Hospital) Costs

• $ 0 monthly premium (for most people)

• $1,408 deductible* per benefit period(up to 60 days)

• $352 per day* for days 61–90 in one benefit period

   $704 per lifetime reserve day (maximum of 60 days)

• NO out-of- pocket limit

* If admitted as inpatient to hospital or skilled nursing facility

 

2021 Original Medicare Part B (Medical) Costs

• A monthly Part B premium ($148.50 in 2021 for most people)

• An annual deductible. A set amount you pay out of pocket for covered services each year before Medicare or your plan begins to pay.

• A copay. A fixed amount you pay at the time you receive a covered service. Medicare or your plan pays the remaining balance.

Coinsurance. A percentage of the cost for a covered service that you pay when you receive it. For example, you might pay 20% and Medicare or your plan would pay 80%.

What Does Medicare Cost?

When Can I Enroll?

Enrolling in Medicare for the the first time

• Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after.

• Your IEP begins & ends one month earlier if your birthday is on the first of the month.

• You should be enrolled in Part A & Part B automatically at age 65 if you are receiving social security or Railroad Retirement Board benefits. Medicare will mail your card to you.

Changing Your Coverage

• After you're enrolled, you have a chance to make changes to your coverage each year during Medicare Open Enrollment October 15th to December 7th.

• Review your coverage choices yearly. Medicare and plan benefits or costs may change.

You still have an Initial Enrollment Period

• Your IEP happens when you turn 65 whether you continue to work or not.

• You have Medicare decisions to make even if you have employer coverage (yours or your spouse's)

Medicare may work with employer coverage

•You may want to enroll in just Part A. It's premium free for most people.

•Some employers require you to take full Medicare benefits (Part A & B) at age 65.

•Check with your employer plan benefits administrator before making Medicare decisions.

Be Proactive

•Make sure you know your IEP dates.

•Medicare will only notify you if you are receiving social security or RRB benefits.

•You may need to sign up for Medicare yourself by contacting the Social Security Administration.

What If I Work Past Age 65?

 
 

Think about your needs so you can see how different coverage options might work for you. Answering the following questions can help you get started.

Your Health

   •How often do you go to the doctor?

   •What health problems do you have?

   •What medications do you take regularly?

Your Preferences

   • Which doctors, hospitals, and pharmacies do you like to go to?

   •How important is it for you to have access to health care while traveling?

   •What other coverage do you have, such as an employer or retiree plan?

Your Budget

   •What are you able to pay each month for premiums?

   •How comfortable are you covering copays or coinsurance for services?

   • How willing are you to accept the risk of high out-of-pocket costs?

How Do I Choose?

 

Learn More

Want to learn more?

Visit MedicareMadeClear.com

Medicare

1-800-MEDICARE (1-800-633-4227), TT 1-877-486-2048

Medicare.gov

Social Security Administration

1-800-772-1213, TTY 1-800-325-0778

SSA.gov

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