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Does Original Medicare automatically include Part A, Part B and Part D?

En español | The original Medicare program (which began in 1966) consists of Part A (hospital insurance) and Part B (medical insurance). If you’re enrolled in original Medicare and want Part D prescription drug coverage (a benefit that was added to Medicare in 2006), you must actively choose and join a Part D drug plan in your area. Medicare offers these different types of coverage so that you can choose which ones you want, according to your individual circumstances.

Here are points to consider in different situations:

  • You can delay enrollment in Part B (which covers doctors’ services, outpatient care and medical equipment) after age 65, without adverse consequences, for as long as you receive primary health care from an employer for which you or your spouse actively works.  
  • If you receive Social Security benefits at the time you turn 65, or apply for them at a later date, the Social Security Administration (which handles Medicare enrollment) will automatically enroll you in both Part A and Part B and send your Medicare ID card through the mail. But (if you have primary insurance from a current employer, as described above) you can decline Part B, following the instructions that Social Security includes in its letter that accompanies your card and meeting the deadline.  
  • If you work for an employer that offers health insurance in the form of a high-deductible plan paired with a health savings account (HSA), be aware that under IRS rules you cannot contribute to an HSA in any month that you are enrolled in any part of Medicare. (If you do, you’ll pay tax on the contributions at the end of the tax year.) If you wish to continue contributing to your account, you need to delay enrollment in Part A as well as Part B. Note that you cannot delay or opt out of Part A if you receive any Social Security benefits (retirement, disability or spousal). 
  • You do not need Part D prescription drug coverage if you have “creditable” coverage from elsewhere — such as from a current or former employer, COBRA, the federal employees health benefits (FEHB ) program, the military’s TRICARE programs, the Veterans Affairs health system, or individual health insurance you’ve purchased yourself. “Creditable” coverage means that Medicare considers it to be of equal or better value than Part D. 
  • If you receive your coverage from Medicaid, the state-run system that provides health insurance to people with incomes under a certain level, this becomes secondary insurance when you become eligible for Medicare. Medicare will settle your Part A and Part B medical bills first and Medicaid will pay for any services that it covers but Medicare doesn’t — plus your premiums, deductibles and copays. You also automatically qualify for full Extra Help, a program that provides Medicare Part D drug coverage at low or reduced cost, but you must actively join a Part D drug plan to get this coverage and pay small copays for your prescriptions. 

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