Original Medicare

Policy Pathways Insurance can help you navigate the confusing path of original Medicare, It's important to fully understand this so you don't end up paying life long premium penalties.

Medicare is made up of 4 parts/options currently but at any given time you will only be using either Part A, Part B and Part D or you may opt for Medicare Advantage Part C. Let's break down what each of these are below:


Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Most of the time Part A will not require a monthly premium if you have paid into Medicare for 40 quarters (10 yrs) through your taxes during your working years. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278 in 2023. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506 in 2023.

If you need to use your Part A benefits, there is a $1600 deductible in 2023 that needs to be met before the plan starts paying. Benefits after your deductible will cover you for up to 60 days of hospitalized care. For days 61-90 you will have a $400 daily coinsurance in 2023. Days 91-159 you would be responsible for a $800 daily coinsurance in 2023. All of these costs would be covered 100% by having the right Medicare Supplement Plan.


Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.

Visits to your Primary Care Physician, Specialists, Surgeries, lab work, and other preventative services are covered under Part B. There is a $164.90 standard monthly premium in 2023 (Higher income earners will pay more based on the previous two tax years) that can be withdrawn directly from your Social Security check, or you could opt to pay the premium from your checking, with this option you will be required to pay 3 months of premium per billing cycle.

There is a yearly deductible of $226 in 2023 that you would have to meet before Part B pays anything, then it is generally 80/20 for Medicare covered services. You are responsible for a 20% coinsurance and any services not covered by Medicare. There is no maximum out of pocket (MOOP) protection from original Medicare however all of these costs except for your Part B deductible would be covered 100% by having the right Medicare Supplement Plan.


Part C, also called Medicare Advantage is an alternative to Original Medicare. Medicare Advantage can be stand-alone (MA) or bundled with prescription drug coverage (MAPD), it usually comes with extra benefits not offered with original Medicare. MA & MAPD are offered through private insurance companies, so you need to enroll through state licensed agent not the Social Security Administration. These plans use networks such as HMO's and PPO's with varied copayments and coinsurance based on services rendered. If you have an MA/MAPD plan, then this becomes your Primary Insurance and Original Medicare gets set aside but you will have to continue paying your Part B premiums ...Original Medicare subsidizes these plans premiums. With this type of plan, you can use a hospital indemnity plan to help cover your deductibles, copayments & coinsurance.


Medicare Part D is prescription drug coverage. Part D coverage is available as a Stand-Alone Option (PDP) for some plans or as part of a Medicare Advantage plan. All prescription drug plans are run by private insurance companies that must follow rules set by Medicare. Be aware that you are required to enroll in a PDP within 63 days of your Medicare Part B start date or maintain credible drug coverage even if you delayed your Part B start date. There will be a lifetime late penalty of 1% of the national base premium for every month you did not have credible coverage ...This penalty will be added to your PDP premium (Higher income earners will pay more based on the previous two tax years).

To learn more about the options of having Original Medicare with a Supplement and Drug Plan or the option of a Medicare Advantage plan with a Hospital Indemnity Plan, please click one of the buttons below. You can also fill out the form & we will contact you within one business day or press the "Click to Call" button above to reach us today!

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