What is Medicare?

Original Medicare is the federal health insurance program for individuals aged 65 and older, as well as younger individuals with certain disabilities. It is composed of two main parts: Part A and Part B.

  • — Inpatient services in hospital

    — Some inpatient care in skilled nursing facilities

    — Hospital and some health care services

    — Operating room and recovery room services

    — Care in special units

    — Inpatient drugs

    — Hospital meals

  • — Doctor visits

    — Outpatient care, such as preventive service

    — Some services not covered by Part A, such as physical or occupational therapy

    — Durable medical equipment

    — Ambulance services

    — Lab tests

    — Urgent care

Medicare Part A and Part B offer distinct coverage options under Original Medicare. Part A focuses on inpatient services, while Part B covers outpatient services. Understanding these differences is crucial for comprehensive healthcare coverage.

 Frequently Asked Questions

  • If you are a U.S. citizen or a legal, permanent resident for five consecutive years and are 65 or older, you are eligible for Medicare.

    If you are under 65 and have received Social Security disability benefits for at least 24 months, you are also eligible.

    Additionally, those with End-Stage Renal Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease), kidney dialysis, or a kidney transplant qualify for Medicare.

  • Every United States citizen qualifies for Medicare Part A upon turning 65. Permanent legal residents of five years, younger individuals with specific disabilities, and those with conditions like End-Stage Renal Disease or Lou Gehrig’s Disease also qualify. Individuals already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board will automatically be enrolled in Medicare. Others will need to apply for Part A with the social security office.

    If you or your spouse has been employed and paid Medicare taxes for 10 years – or 40 quarters – you will receive Part A at no additional cost.

  • Medicare Part B has the same eligibility requirements as Part A. However, there is a standard monthly premium for Part B. Individuals who are considered “high earners” will pay a higher premium. This is calculated based on the individual’s adjusted gross income from two years prior.

  • Yes, you can have additional coverage such as Medigap, Medicare Advantage, or employer-provided insurance along with Original Medicare.

  • Medicare Part C, also known as Medicare Advantage, is offered by private insurance companies and provides additional benefits beyond Original Medicare Parts A and B.

  • Enrollment periods include the Initial Enrollment Period (IEP), General Enrollment Period (GEP), and Special Enrollment Period (SEP). The IEP starts three months before you turn 65 and ends three months after your 65th birthday. 


    Find out more information about Medicare enrollment periods by visiting our Medicare Enrollment Periods blog.

Questions before getting started? Get in touch.

At Gold Valley Benefits Group, we provide personalized consultations to help you understand and enroll in Medicare, ensuring you get the best coverage. We offer detailed guidance, explaining the benefits and costs of Parts A and B, and assist you in deciding if additional coverage is needed.