What Is Original Medicare?
Original Medicare includes Parts A and B and it’s the starting point for most people turning 65 or leaving employer coverage. At Schatz Benefits, we help Minnesotans understand how these two parts work, what they cover, and what else you might need to fill the gaps. Whether you're just getting started or comparing options, we’re here to help make sense of it all.
Medicare Part A – Hospital Insurance
Medicare Part A helps cover care when you’re admitted to a facility. That includes:
Most people don’t pay a premium for Part A if they’ve worked and paid Medicare taxes for 10 years. You’ll still be responsible for deductibles and coinsurance, but we’ll help you estimate those costs ahead of time.
Inpatient hospital stays
Skilled nursing facility care (after a hospital stay)
Hospice care
Some home health services
Medicare Part B – Medical Insurance
Part B covers the care you receive outside of a hospital. This includes:
Doctor visits and outpatient services
Preventive care (like screenings and vaccines)
Lab work and diagnostic tests
Mental health services
Durable medical equipment (like walkers or oxygen)
Part B typically comes with a monthly premium, an annual deductible, and 20% coinsurance. Your costs may vary based on income and the services you need. We’ll help you understand what’s covered, and what’s not.
Why Most People Add More Coverage
Original Medicare is a great start, but it doesn’t cover everything. Here’s what’s not included—and why it matters:
Prescription Drugs (Part D)
Original Medicare doesn’t include coverage for most outpatient prescriptions. Without a Part D plan or a Medicare Advantage plan with drug coverage, you could pay full price for your medications—and may face a late enrollment penalty down the road.
Dental, Vision & Hearing Care
Routine dental checkups, glasses, hearing aids, and cleanings aren’t covered under Parts A or B. If these services are important to you (and for most people, they are), we can help you find supplemental coverage or an Advantage plan that includes them.
Long-Term Care
Original Medicare doesn’t cover extended nursing home care, custodial care, or assisted living. If you’re planning ahead for the future, we can walk through additional coverage options and costs for long-term support.
Out-of-Pocket Cost Limits
Unlike most health plans, Original Medicare has no annual cap on your out-of-pocket spending. That means there’s no limit to what you could pay in coinsurance and deductibles in a bad health year. Medigap and Advantage plans help protect against this.
Common Questions About Medicare A & B
Do I have to enroll in Medicare at age 65?
If you’re already receiving Social Security benefits when you turn 65, you’ll be enrolled automatically in Parts A and B. If not, you’ll need to enroll during your Initial Enrollment Period, which starts three months before your 65th birthday. Missing this window could lead to late penalties—unless you have qualifying coverage like employer insurance.
Can I delay Part B if I have employer coverage?
Yes—if you’re still working and have credible coverage through an employer (either your own or your spouse’s), you can delay Part B without penalty. Once you stop working or lose that coverage, you’ll qualify for a Special Enrollment Period to add Part B. We’ll help you time this transition so there’s no lapse in coverage or financial penalty.
What if I only want Part A for now?
That’s possible, and it’s common for people still working past 65. Many choose to enroll in Part A (which is usually premium-free) and delay Part B if they’re covered through work. But every situation is different. We'll review your employer plan and walk through what makes sense for you.
Does Original Medicare include dental or eye exams?
No. Parts A and B do not cover routine dental, vision, or hearing services, including checkups, glasses, or hearing aids. However, some Medicare Advantage plans offer these as added benefits. We can help you compare plans that include the extras you care about.
How much will I pay with just A & B?
With Original Medicare alone, you’ll pay a Part B premium (based on income), deductibles, and 20% coinsurance on most services. There's also no out-of-pocket maximum—so your costs could add up quickly in the event of a major illness or injury. That’s why many people add a Medigap plan or Medicare Advantage plan for more predictable costs.
Let’s Build a Medicare Plan That Starts with the Right Foundation
Medicare Parts A & B are just the beginning, but understanding them sets the stage for smarter coverage decisions. We’re here to walk you through every step with plainspoken guidance and local support.