The Alternative To Original Medicare Is Medicare Advantage.

The term "Original Medicare" refers to Medicare Part A and Part B. Part A helps cover the cost of hospital-related care, including inpatient services, lab tests and surgery. Part B is the medical insurance component of Medicare, which helps cover doctor visits, outpatient care and certain preventive services. The federal government administers both Part A and Part B.

Medicare Advantage plans are offered by private insurance companies contracted by the federal government. Medicare Advantage, also referred to as Medicare Part C, covers the same healthcare services as Original Medicare, except for hospice care. Many Medicare Advantage plans also include prescription drug coverage.

In addition, many Medicare Advantage plans include coverage for routine vision, dental and hearing care. Health and wellness benefits like fitness programs may be offered, as well.

Medicare Supplement insurance, or Medigap coverage, may help pay some healthcare costs that Original Medicare doesn't pay. These may include:

• Co-Payments
• Co-Insurance
• Deductibles

Medicare Part D , also called Medicare prescription drug coverage, is optional coverage to help Medicare beneficiaries pay for self-administered prescription drugs. It can cover most prescription drugs. The Medicare Part D plans should cover various prescription drugs that people with Medicare take. You can get Medicare Part D through private insurance as a stand-alone plan or as an add-in through a Medicare Advantage plan.

Learn more about Medicare

Enrolling in Medicare can seem challenging. However, by understanding enrollment periods and eligibility requirements, enrolling in Medicare can be quite simple. Learn about your eligibility and how to enroll in Medicare.

Who is eligible for Medicare?

Medicare eligibility depends on factors such as:

• Age: You must be 65 years or older to enroll in a Medicare plan. You can receive Part A without a premium if you are receiving or eligible to receive benefits from Social Security or the Railroad Retirement Board. In addition, you can qualify for a premium-free Part A, if you or your spouse had Medicare-covered government employment.
• Disability: If you are under 65 years old and have a disability, you qualify for Medicare. End Stage Renal Disease: With this disease, you are experiencing permanent kidney failure and require dialysis or a transplant. You qualify for Medicare.

If you have not been paying for Medicare taxes while you worked, are older than 65 and are a citizen or permanent resident of the U.S., you may have to purchase Part A.

If you are younger than 65, you can receive Part A without a premium if:

• You have been granted Social Security or Railroad Retirement Board disability benefits for at least 24 months.

You are a patient that requires a kidney transplant or dialysis.

Most people do not have to pay for Part A. However, if you want Medicare Part B, you must pay for it. The premium is deducted monthly from your Social Security, Railroad Retirement or Civil Service Retirement check. If you do not receive these types of payments, you will receive a bill every 3 months from Medicare.

Is Medicare Mandatory?

Medicare is not mandatory. However, if you do not enroll for Medicare Part B (medical insurance) when you are first eligible, you may have to pay a higher premium cost.

If you turn 65 and still have insurance through an employer or union, you can keep that insurance and wait to enroll in Medicare, using a Special Enrollment Period (SEP).

How Do I Sign Up For Medicare?

In many cases, eligible individuals will automatically be enrolled; others may need to apply for Medicare independently.

If this is the case, it is essential to sign up during the initial enrollment period (IEP) , which is around your 65th birthday or 25th disability check.

You will have a 7-month period to browse options and sign up, including your birth month, the 3 months before, and the 3 months after your birth month.

If your birthday is the first of the month, you will be treated as if you were born the month before your birth month.

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Medicare coverage is dependent on when you have signed up and your sign-up period. Coverage always starts on the first of the month.

If you meet the criteria for Premium-free Part A, your coverage starts the month you turn 65-years old or the month before if your birthday is the first of the month.

Part B and Premium-free Part A start dates are dependent on sign-up:

You can also sign up for Premium-free Part A after your 65th birthday. Coverage starts 6 months back from sign-up or when you apply for benefits from Social Security or the Railroad Retirement Board.

After your IEP is over, you can only sign up for Part B and Premium-free Part A during the other periods of General Enrollment or Special Enrollment.

For Original Medicare, the General Enrollment Period is Jan. 1 – March 31, with coverage starting the month after you sign up. You may have to pay a monthly late enrollment penalty if you do not qualify for Special Situations.

Under Special Situations or the SEP, you can sign up for Part B and Premium-free Part A without paying a late enrollment penalty. Your coverage will start next month. Access your situation and find out when to sign up.

You can enroll in a Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period from Jan. 1 – March 31. You can also join a new plan, switch plans or drop a Medicare Advantage plan during the Open Enrollment Period from Oct. 15 – Dec. 7.

What Happens If I Miss The General Enrollment Period?

If you miss the General Enrollment Period, you may qualify for a Special Enrollment Period (SEP).

Can I Enroll In Medicare With A Pre-Existing Condition?

Yes, even with a pre-existing condition , you can enroll in Original Medicare or a Medicare Advantage plan if you sign up for coverage during your IEP.

Here are some answers to frequently asked questions about Medicare costs.

How Much Does Medicare Cost?

Medicare costs consist of a monthly premium for Medicare coverage and a portion of the costs of covered services. There is no yearly limit on out-of-pocket expenses unless you have a Medicare Advantage plan.

How much do Medicare Part A and Part B premiums cost?

Most people don't have to pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while they were working.

There's also no premium for Part A if:

• You're receiving Social Security.
• You've received disability benefits for at least 24 months

There is a monthly premium for Part B, which is deducted from your Social Security or, for those who receive them, from their Railroad Retirement Board (RRB) benefits. For 2025, the standard premium for Part B coverage is $185 or higher, depending on your income.1

In addition to premiums, plan members are also responsible for paying a deductible and coinsurance with Original Medicare. The 2025 deductible for inpatient hospital stays is $1,676 per benefit period. The 2025 annual deductible for Part B is $257. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services.

With Medicare Advantage options, instead of paying your healthcare bills directly, the federal government pays private insurance companies to administer your coverage.

While there is a monthly premium for Medicare Advantage options, many private insurance companies choose to offer affordable or $0 plan premiums to compete for your business. They also set the guidelines for your deductible, coinsurance and copays. To learn about Medicare Advantage options, you can make an appointment with a licensed sales agent .

As with Original Medicare members, Medicare Advantage members must continue to pay their Part B premium.

The Medicare Giveback Benefit, also known as The Part B Giveback, is a Part B premium reduction offered by some Medicare Part C (Medicare Advantage) plans.

If you enroll in a Medicare Advantage plan with this benefit, the plan carrier will pay some or all your Part B monthly premium. The amount covered can range from 10 cents to the total Part B premium cost ($185 in 2025).

Medicare coverage can seem confusing and overwhelming at first. Here are some answers to frequently asked questions related to Medicare coverage.

What Does Original Medicare Cover?

Original Medicare consists of Medicare Part A and Part B.

Medicare Part A (also known as hospital insurance) generally covers inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare.

Medicare Part B (also known as medical insurance) offers coverage for medically necessary and preventive care services. Essential medical services diagnose and treat health problems.

It can include durable medical equipment (DME), mental healthcare or ambulance services. Preventive care services are health treatments that prevent illness or detect problems early, like flu shots or cancer screenings.

Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include:

• Routine Foot Care
• Cosmetic Surgery
• Long-Term Care
• Dentures

Many Medical Advantage plans include dental benefits, and additional dental plans are available for your needs.

Do Medicare Plans Offer Prescription Drug Coverage?

There are 2 ways to get Medicare prescription drug coverage:

• You can choose a Medicare Advantage plan that includes prescription drug coverage (these are called Medicare Advantage prescription drug plans).
• You can purchase a stand-alone prescription drug plan —called Part D—to add to your Original Medicare.

Your out-of-pocket costs for prescription drug deductibles, copays and coinsurance vary from plan to plan. Check each plan's Drug List (list of covered drugs) to see what prescription drugs are covered.

Most healthcare providers do accept Medicare. 97% of physicians and practitioners billing Medicare are participating healthcare providers of Medicare.

Can I Choose My Healthcare Provider?

With Original Medicare, a primary care provider is not required. You can visit any healthcare provider who accepts Medicare.

With a Medicare Advantage plan, your choice of doctor depends on whether you select a health maintenance organization (HMO) or preferred provider organization (PPO) plan.

With an HMO plan, you can choose your primary care doctor from any doctor in the plan's network. If you opt for a PPO plan, generally, choosing a primary care doctor is optional. With both types of plans, you'll usually save money by visiting an in-network provider.

It's important to note that Medicare Advantage plans must offer emergency coverage outside the plan's service area, anywhere in the U.S.

The comprehensive healthcare reform law, known commonly as ACA or Obamacare, requires qualified insurers to provide individual health insurance plans to enrollees that meet the minimum essential coverage requirements. These plans are designed to make healthcare more affordable and to provide coverage to everyone, including those with pre-existing conditions.

With an ACA health plan, you pay a monthly premium and typically, a co-pay when you visit your doctor. When choosing your plan, it's important to look at the deductible, which is the amount of money you pay before your insurance "kicks in,"" and your out-of-pocket maximum, which is the total amount of money you pay annually before your insurance covers you 100%.

Also, keep in mind, that while all ACA health insurance plans include dental and vision coverage for children, they may not include it for adults. If you need vision and dental coverage, and your plan doesn't include it, you'll have to purchase it separately.

Short-term health insurance is designed to fill gaps in coverage. It’s ideal for people who are:

• Switching jobs and in-between benefits.
• Waiting to be Medicare-eligible.
• Not qualified for an ACA plan, but will have other insurance in the near future.
• Transitioning from their parent's health insurance plan to their own.

Keep in mind, short-term limited duration insurance policies are not required to meet federal standards for comprehensive health coverage and is not comprehensive health coverage. STLDI plans are temporary, limited policies with fewer benefits and Federal protections than other types of health insurance options, like those available on HealthCare.gov. This policy may not cover you due to preexisting health conditions (ex. diabetes, cancer, stroke, arthritis, heart disease, mental preexisting health conditions health and substance use disorders), and it may not cover certain prescription drugs, preventive screenings, maternity care, emergency services, hospitalization, pediatric care, physical therapy, and more.

Fixed indemnity plans aren’t traditional health insurance coverage. These plans are designed to supplement your health insurance by reimbursing you for out-of-pocket expenses you pay on covered medical treatments and procedures.

For example, if your health insurance has a $500 deductible for emergency room visits, this is what you pay if you receive treatment at the ER. Then, you can submit your receipts to the provider who manages your fixed indemnity plan for reimbursement.

Keep in mind, fixed indemnity plans don’t cover pre-existing conditions. In fact, they typically have a list of specific procedures and medical treatments that are covered, so make sure you understand when you’re reimbursed and when you aren’t before you buy.

Also, the amount of costs reimbursed to you could affect your Medicaid eligibility (if applicable).

Community/cost-sharing plans are not real health insurance plans. These plans are designed to supplement your health insurance in an effort to help you manage costs. When you purchase a cost-sharing plan, you aren’t buying health insurance. Instead, you’re buying into a community plan that pulls everyone’s monthly payments together and uses that money to help pay for its member’s out-of-pocket medical expenses.

Keep in mind, each program has specific guidelines. Before you buy, make sure you know what type of medical expenses you can get reimbursed for.

What should I ask the agent when I speak to them on the phone to ensure I get the plan I need?

When exploring your health plan options, you can ask the agent these questions to help determine if the coverage fits your needs.

• Is this a managed care or an indemnity plan?
• Is this plan ACA compliant?
• Is this a cost-sharing plan or is it real health insurance?
• Is this health insurance or a plan that supplements my current health insurance?
• How much money do I have to pay out-of-pocket annually for medical care?
• Is there a co-pay for doctor visits? If so, what is it? Is there a separate co-pay for specialists?
• Does this plan include dental, vision care, and other special services?
• Can I continue seeing my current doctors?
• Are preventative or routine exams covered?
• Does the plan cover pre-existing conditions? If not, what’s excluded?
• Are prescription costs covered?
• Does this plan have a deductible? If so, how much is it and when does it apply?