Original Medicare

Original Medicare is the federal government’s health insurance program, which is available to most Americans who are 65 and older. It is provided entirely through the government, and beneficiaries can receive treatment and services from any doctor who is enrolled in Medicare.

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Written by
Christian Simmons
Christian Simmons
Financial Writer
Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.
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Edited By
Lamia Chowdhury
Lamia Chowdhury
Financial Editor
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.
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Reviewed By
Michael Jones
Michael Jones
Medicare Expert and Owner of Grand Anchor Insurance Solutions
Michael Jones is a licensed insurance agent who manages his own agency called Grand Anchor Insurance Solutions. In addition to being a Medicare expert, Michael specializes in other insurance products such as voluntary benefits for employees of businesses.
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Published: February 16, 2022
Updated: October 20, 2023
5 min read time
This page features 6 Cited Research Articles

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Key Takeaways

Original Medicare is the health plan provided through the government. It is available to most Americans when they turn 65 but can be available earlier if you have ALS or end-stage renal disease.
Original Medicare is divided into Parts A and B. Part A covers hospital stays and inpatient care, while Part B covers medically necessary treatments and services.
Coverage through Original Medicare is not all-encompassing — there are key areas like vision care, dental care and most prescription drugs that are not covered.

What Is Original Medicare?

Original Medicare can be used to cover your health care needs after you turn 65. The program is available across the country to all Americans who meet certain requirements. Original Medicare covers doctor visits, treatments, services and hospital stays.

Coverage is divided into two parts — Parts A and B — that will each cover different areas of your health care.

Did You Know?

President Lyndon B. Johnson signed Medicare and Medicaid into law in 1965. At the time, 56% of Americans over the age of 65 were not covered by health insurance. One million people enrolled in the program its first week. Today there are over 58 million Medicare beneficiaries.

Source: Kaiser Family Foundation

Medicare Part A

If you have Original Medicare, Part A is your hospital insurance. It will help cover hospitalizations, as well as stays in a skilled nursing facility or hospice care. Original Medicare does not cover long-term care however, so Part A will not cover a permanent move to a nursing home.

Medicare Part B

Part B covers medically necessary care and preventive services. It will cover your doctor visits, outpatient care and treatments. Part B will also cover some medical equipment as well as tests and screenings, such as diagnostic tests.

Chart showing what Medicare Part A and Part B Cover

Original Medicare Enrollment & Eligibility

Most Americans are eligible for Medicare when they turn 65. To be eligible for premium-free Part A, you must have worked and paid Medicare taxes for at least 40 quarters or have a spouse that is eligible. Some Americans are eligible before they turn 65 if they have certain disabilities, including ALS and end-stage renal disease.

If you are already receiving Social Security when you turn 65, you should automatically be enrolled in Original Medicare. If not, you have a window to enroll that starts three months before the month of your 65th birthday and ends three months after. You will be penalized if you don’t enroll during your initial window.

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Original Medicare Deductibles & Costs

If you meet the Medicare tax quarters requirement, then you will be eligible for premium-free Part A coverage. This just leaves you with your deductible, which is $1,676 for 2025.

You will also have to pay a coinsurance of $419 per day starting on your 61st day in the hospital. That figure jumps to $838 for every day after day 90, which are known as lifetime reserve days. If you exhaust all 60 of your reserve days, you will then pay all costs.

If you or your spouse haven’t met the requirement of working for 40 quarters, you can still buy into Original Medicare by paying a premium for Part A.

For Part B, you will pay a monthly premium of $185. You will also have to meet a deductible of $257 before Medicare begins to pay.

Premiums, deductibles and coinsurance costs change every year.

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What Does Original Medicare Cover?

Original Medicare covers treatments, services and procedures that are medically necessary. This typically means that a doctor must verify that you do need care.

Under Part A, coverage can include hospital stays and inpatient care. Under Part B, a variety of things are included such as regular doctor visits and lab tests.

What Medicare Covers

Ambulance Services
Clinical Research
Hospital Care
Medically Necessary Services
Mental Health
Preventive Services
Some Limited Prescription Drugs

Original Medicare also covers mental health services and some limited outpatient prescription drugs.

What Is Not Covered by Original Medicare?

Some of the biggest areas that are not covered under Original Medicare are vision and dental. Coverage for vision and dental is typically only available through Medicare Advantage plans, which are provided by private insurers and can include additional coverage beyond the scope of Original Medicare.

Original Medicare also usually does not cover cosmetic procedures and services, or anything that isn’t of medical significance.

Areas Not Covered Under Original Medicare

Dental
Vision
Long-Term Care
Hearing Aids
Cosmetic Surgery
Routine Foot Care
Acupuncture

Hearing aids or exams to fit them are also not covered. More minor services like acupuncture or routine foot care are also typically exempt from coverage.

Frequently Asked Questions About Original Medicare

How do you know if you have Original Medicare?

If you were already receiving Social Security when you turned 65, you should automatically be enrolled in Original Medicare. Otherwise, you will have to enroll yourself to get it. Original Medicare is provided through the federal government. If you enroll in a private Medicare plan, then you have Medicare Advantage.

How to switch back to Original Medicare?

If you have Medicare Advantage, you can switch back to Original Medicare during certain enrollment periods. You can change your plan during open enrollment, which runs from Oct. 15 to Dec. 7. If you currently have Medicare Advantage, you can also switch back during the general enrollment period that lasts from Jan.1 to March 31.

What are the benefits of Original Medicare?

With Original Medicare, there are few limits on where you can receive your care. You can visit any doctor who is enrolled in Medicare and don’t need a referral to visit a specialist. If you have a Medicare Advantage plan, then you must remain within the plan’s network and can usually only receive care from specified doctors.

Last Modified: October 20, 2023

Christian Simmons Financial Writer

Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics for RetireGuide. His unique blend of business and writing backgrounds has equipped him to understand complex retirement topics and convey that information in an informed and easily digestible way.

Certified educator in personal finance
Bachelor’s degree in journalism from the University of Central Florida Burnett Honors College
Master’s degree in integrated business from the University of Central Florida

Edited By

Lamia Chowdhury Financial Editor

Reviewed By

Michael Jones Medicare Expert and Owner of Grand Anchor Insurance Solutions

6 Cited Research Articles

U.S. Centers for Medicare & Medicaid Services. (2023, October 12). 2024 Medicare Parts A & B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
U.S. Centers for Medicare & Medicaid Services. (2022). Costs. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
U.S. Centers for Medicare & Medicaid Services. (2022). Compare Original Medicare and Medicare Advantage. Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
U.S. Centers for Medicare & Medicaid Services. (2022). How Original Medicare Works. Retrieved from https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/how-original-medicare-works
U.S. Centers for Medicare & Medicaid Services. (2022). What’s Not Covered by Part A and Part B. Retrieved from https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b
U.S. Centers for Medicare & Medicaid Services. (n.d.). Original Medicare (Part A and B) Eligibility and Enrollment. Retrieved from https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol