Who qualifies for original Medicare?

Asked by: Schuyler Denesik DDS  |  Last update: February 22, 2025
Score: 4.3/5 (3 votes)

If you're receiving Social Security or Railroad Retirement Board benefits four months prior to your 65th birthday, you'll be automatically enrolled in Original Medicare (Parts A and B). Most people qualify for Original Medicare (Parts A and B) when they turn 65.

Who is eligible for original Medicare?

Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).

Are you automatically enrolled in original Medicare?

You'll get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically when you turn 65. You'll still need to make important decisions about your coverage, like whether you need to add drug coverage.

How do I know if I have original Medicare?

If you receive your Part A and Part B benefits directly from the government, you have Original Medicare. If you receive your benefits from a Medicare Advantage organization or other private company approved by Medicare, you have a Medicare Advantage plan.

What is the difference between traditional Medicare and original Medicare?

Traditional Medicare (also called Original Medicare) includes Medicare Part A and Part B, which give you inpatient and outpatient coverage. The difference with Medicare Advantage plans (Part C) is that they include Part A and Part B coverage, plus much more.

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Can I drop my Medicare Advantage Plan and go back to original Medicare?

Medicare Advantage Open Enrollment Period: Between January 1 and March 31 of each year, if you already have a Medicare Advantage Plan (with or without drug coverage) you can: Switch to another Medicare Advantage Plan (with or without drug coverage). Drop your Medicare Advantage Plan and return to Original Medicare.

Does everyone have to pay $170 a month for Medicare?

Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

Do you have to pay for original Medicare?

Most people get Part A for free, but some have to pay a premium for this coverage. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child.

What is the best Medicare plan that covers everything for seniors?

Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.

Why are people leaving Medicare Advantage plans?

But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up paying more in the long run in copays and deductibles if they develop a serious illness.

What is the penalty for switching from Medicare Advantage to original Medicare?

There is no penalty for switching from Medicare Advantage to Original Medicare. And, if you decide you want to switch again, there's also no penalty to switch from Original Medicare to Medicare Advantage. You can switch between the two types of coverage as many times as you want.

What are the three requirements for Medicare?

Eligibility rules are based on citizenship, age and disability. Workers pay into the program to accumulate credits but also pay premiums. Expect prescription, Medigap premium or Medicare Advantage expenses.

Can I drop my employer health insurance and go on Medicare Part B?

Once you stop working (or lose your health insurance, if that happens first) you have an 8-month Special Enrollment Period (SEP) when you can sign up for Medicare (or add Part B to existing Part A coverage).

When can I enroll in Original Medicare?

If you are 65 or older, you are eligible to enroll in Original Medicare.

Who qualifies for an extra $144 added to their social security?

To qualify for a Medicare giveback benefit, you must be enrolled in Medicare Part A and B. You must be responsible for paying the Part B Premiums; you should not rely on state government or other local assistance for your Part B premiums.

Why do people choose original Medicare over Medicare Advantage?

There's no one-size-fits-all answer, but Medicare Advantage typically has lower premiums and optional coverage, while Original Medicare often gives you more choice when it comes to choosing doctors.

What are the 6 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:
  • Eye exams (for prescription eyeglasses)
  • Long-term care.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

Why do people say not to get a Medicare Advantage plan?

Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.

Do all hospitals accept Original Medicare?

While most hospitals do accept Original Medicare, there may be some that do not accept Medicare Advantage Plans.

Why is Social Security no longer paying Medicare Part B?

There could be several reasons why Social Security stopped withholding your Medicare Part B premium. One common reason is that your income has exceeded the threshold for premium assistance. Another reason could be that there was a mistake or error in your records.

How much money can you have in the bank if you're on Medicare?

There is no limit on the amount of cash you can have with Medicare Part A. You do have to have paid taxes for 40 quarters (10 years) during your working lifetime and you have to be age 65 unless otherwise qualified due to a social security eligible disability.

Is Medicare free at age 65 for seniors?

$0 for most people (because they or a spouse paid Medicare taxes long enough while working - generally at least 10 years). If you get Medicare earlier than age 65, you won't pay a Part A premium. This is sometimes called “premium-free Part A.”

How much does Medicare take out of your Social Security check?

If you have Medicare Part B medical insurance, your premiums are automatically deducted from your Social Security check and your monthly premiums are based on your income. Most Part B enrollees will have $185 deducted from their Social Security each month in 2025. The amount increases if you have a high income.