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Original Medicare: Parts A & B

Original Medicare is low-cost health insurance that comes from the government. It covers things like hospital stays and check-ups. Most people get it when they turn 65, but there are lots of things that it doesn’t cover. We have plans to enhance your Original Medicare coverage, help you pay for the things it doesn’t cover, and help save you money. Let’s talk about Original Medicare, what it covers, and what it doesn’t.

What is Original Medicare?

Original Medicare is made up of Parts A and B. Each covers different parts of your care.

Medicare Part A

Hospital Insurance

Part A includes:
  • Skilled nursing care
  • Inpatient hospital stays
  • Hospice care
  • Some in-home care
Medicare Part B

Medical Insurance

Part B includes:
  • Doctor visits
  • Preventive care
  • Outpatient services
  • Medical supplies
  • Tests and X-rays

Paying for Original Medicare

Let’s look at how most people pay for Original Medicare.

Part A

You may have to pay a premium for Part A, but most people don't. If you or your spouse paid taxes into Medicare while you were working, you won’t have to pay premiums for Part A. If not, you can buy Medicare Part A and we can help cover some of its expenses.

Part B

The cost of Part B varies depending on your income. Social Security uses your tax information to find out what you should pay. Most people pay either $104.90 or $121.80 a month for the Part B premium, and it can be deducted automatically from your Social Security check each month.

Medicare Preventive Health

Take advantage of preventive care! It’s one of the best things you can do for your health. Regular check-ups, tests, shots and screenings can protect you from disease or injury, or lead to early detection and more effective treatment. Original Medicare pays for many preventive health services, and some of our plans cover even more. Here’s a list of preventive services included with Medicare Part B.

Pneumococcal
Flu
Hepatitis B (for people at medium to high risk)

One-Time “Welcome to Medicare” preventive visit (within the first 12 months of having Part B)
Yearly “Wellness” visits

Abdominal aortic aneurysm (for people at risk)
Alcohol misuse (screening and counseling)
Bone mass measurement
Breast cancer (mammograms)
Cardiovascular disease
Cervical and vaginal cancer
Colorectal cancer
Depression
Diabetes (for people at risk)
Glaucoma (for people at high risk)
Hepatitis C (for certain ages and people at high risk)
HIV (for people at increased risk)
Pap test
Prostate cancer
Sexually transmitted infections (screening and counseling)

Cardiovascular disease (intensive behavioral therapy)
Diabetes self-management training
Medical nutrition therapy (for people with diabetes or renal disease)
Obesity (intensive behavioral therapy)
Smoking and tobacco use cessation counseling

Medicare Doesn’t Cover Everything But We Can Help

Though Original Medicare pays for many services, it doesn’t pay for everything. Medicare Advantage, Prescription Drug (Part D), Medicare Supplement Plans, and optional vision and dental plans are available for Medicare Eligibles to help you with the things that aren’t covered.

  • Prescription drugs are not covered by Original Medicare, but a Prescription Drug (Part D) Plan can help you save money on your prescription drugs. A Medicare Advantage Plan with Drug Coverage can too.

  • Original Medicare will only pay 80 percent of the cost of doctor visits. With a Medicare Advantage plan you will pay a small copay for doctor visits. Medicare Supplement plans can cover some or all of the costs of doctor visits not covered by Original Medicare.
  • Original Medicare will only pay a certain amount per day for hospital stays up to 150 days. With Medicare Advantage you will usually pay a lower copay per day for hospital stays. Medicare Supplement plans can cover some or all of the costs not covered by Original Medicare for hospital stays.

  • Medicare doesn’t cover regular vision exams, eyeglasses or contacts and it also doesn’t cover most dental care. But many of our Medicare Advantage Plans offer vision, dental and hearing coverage.
 
Empire offers Medicare Advantage and Medicare Supplement plans in the eastern and southeastern regions of the state. Empire currently doesn't offer standalone Medicare Part D plans in New York. Depending on the plan you choose, it may help you pay for some of what Medicare doesn’t cover.
 
And, in most states, you can add one of Empire’s optional dental or vision packages can easily be added to your Medicare Supplement or Medicare Advantage plan to complement your coverage. You get allowances for the glasses or contacts you rely on and your check-ups and eye exams will be covered.
 

Need help paying for Original Medicare?


If you need help paying for the costs of Original Medicare, like deductibles or premiums, there are lots of programs to help. You can also apply for a Medicare Savings Program to help cover for the costs of Original Medicare. To find out if you qualify for one of these programs, visit Medicare.gov or call your state’s Medicaid or local Social Security office. If you already have Medicaid or are enrolled in certain levels of the Medicare Savings Program, you may be eligible for a Dual Special Needs (DSNP) plan. These plans are designed for people who have Medicare and Medicaid and have no premium or medical copays or deductibles.

Need to Know When and How to Sign up for Medicare?

We can help you understand the rules about when and how to sign up for Original Medicare and the Medicare plans we offer such as Medicare Advantage and Medicare Supplement on our Sign Up for Medicare page.

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