Medicare (Parts A & B)

Medicare (Parts A & B)

The Details

Original Medicare (Parts A & B) are available for enrollment through the Medicare.gov website. Unlike the other insurance policies we offer through our company and partners, we only provide information and context about Medicare A & B so our clients have everything they need to make informed decisions. Because Original Medicare does not cover everything, we want to make sure you have enough information to build a complete plan around it.

Original Medicare is the federal government's healthcare program for people turning 65 or qualifying due to specific disabilities. It is divided into two primary parts that form your foundational medical safety net.

Part A (Hospital Insurance)

Functions as your hospital insurance, helping cover inpatient hospital stays, skilled nursing facility care, hospice, and certain home health services. Most individuals receive Part A premium-free if they or their spouse paid Medicare payroll taxes for at least 10 years.

When You Get Part A Automatically

• Social Security or Railroad Retirement Board (RRB) Benefits: If you already receive benefits from Social Security or the RRB at least 4 months before turning 65, you are automatically enrolled in Medicare Part A and Part B starting the month you turn 65.
• Disability: If you receive disability benefits from Social Security or the RRB for 24 months, you are automatically enrolled in Part A and Part B on your 25th month of disability.

When You Must Manually Sign Up

• Turning 65 and Not on Social Security: If you are not collecting retirement benefits yet, you must actively apply through the Social Security Administration during your Initial Enrollment Period (the 7-month window around your 65th birthday) if you want coverage.
• Working with Small Employer Coverage: If you are still working and covered by an employer group health plan with fewer than 20 employees, Medicare is primary, so you must sign up for Part A and Part B when you first turn 65.
• Paying for Part A: If you or your spouse did not work long enough to qualify for premium-free Part A (typically 40 quarters or about 10 years of paying Medicare taxes), you must sign up and pay a monthly premium if you want the coverage.

When You Can Delay Signing Up

• Working with Large Employer Coverage: If you are still working at age 65 (or covered by an active working spouse's plan) at a company with 20 or more employees, you do not have to sign up for Part A or Part B right away. You can delay without penalty and get a Special Enrollment Period later when you retire or lose that coverage.

Part B (Medical Insurance)

Acts as your medical insurance, covering doctor visits, outpatient care, durable medical equipment, and preventive clinical screenings. Unlike Part A, Part B requires a standard monthly premium that can scale based on your individual income level.

Key Rules About Part B Enrollment

• When you turn 65: You have a 7-month Initial Enrollment Period (3 months before, the month of, and 3 months after your 65th birthday) to sign up for Original Medicare (Part A and B).
• If you are still working: You can delay signing up for Part B without a penalty if you or your spouse are actively working and covered by a current employer group health plan (from an employer with 20 or more employees).
• The 8-Month Special Enrollment Period: Once that current employer coverage or employment ends, you get an 8-month Special Enrollment Period to sign up for Part B penalty-free.
• COBRA and Retiree Plans: COBRA and retiree health insurance do not count as active employer coverage, so they do not extend your window to avoid late penalties.

Together, Original Medicare covers roughly 80% of approved medical expenses, leaving the remaining 20% coinsurance uncovered without an annual out-of-pocket spending cap. It does not cover everything (such as prescription drugs, routine dental, or vision). That is why building a complete plan around Parts A and B is essential.