Decoding Original Medicare

October 29, 2016

Managed by the federal government, Original Medicare is the plan most people will choose while enrolling with Medicare, or they may be automatically enrolled, if they have been paying social security taxes while employed for at least ten years.

According to research, two-thirds of seniors decide to take this traditional route.  Original Medicare consists of Part A, which covers hospital insurance, and Part B that covers medical insurance.  Prescription Drug Plans (Part D) are often considered part of Original Medicare as well. Customers may have to enroll with a Part D plan to get additional prescription drug coverage not offered by part B.

It is important to understand what an insurance plan offers, before selecting one that is best suited to particular needs. If automatically enrolled, beneficiaries should thoroughly check all plans for coverage and costs, and change if necessary to get suitable benefits and important cost savings.

Consumers considering Original Medicare should completely understand what Part A and Part B offer. In this article, we simplify important considerations in an easy to follow manner.

For Part A, beneficiaries should be aware of the following:

  • Part A covers the cost of hospital care. This usually includes a semi-private room, meals, nursing care, tests, drugs, and other services and supplies that may be required while at a hospital due to an illness or surgery.  Personal physician services are also usually covered.
  • Part A does not cover personal care in the hospital. This may include help with eating, bathing or dressing, and paying for individual phone or television charges.
  • Part A pays most of the cost of a stay up to 60 days. If you are in the hospital for longer than that, you may have to pay a larger share of cost.
  • Part A assists to pay for care received in a skilled nursing facility and through home or hospice care. If you are discharged from the facility and readmitted within 60 days of your discharge, you are covered under the deductible you paid when you were admitted the first time.  If you are readmitted after 60 days of your first admission, an additional deductible has to be paid.
  • If you or your spouse has been contributing to Medicare through payroll deductions for at least ten years, Part A does not charge a premium.

For Original Medicare Part B, beneficiaries should know the following:

  • Part B will make up 80% of your Original Medicare Plan.
  • It covers medical insurance including doctor visits and physician services at the hospital. It also covers some preventive services, ambulance services, mental health care, and durable medical equipment, such as wheelchairs, walkers, and blood sugar monitors, as prescribed by your doctor.  It may also cover clinical research and limited outpatient prescription drugs.
  • Not all prescription drugs are covered by Plan B; check for these. Your costs might increase significantly if you have to opt for additional prescription drug coverage in the form of Plan D.
  • Part B is not premium-free. It charges a monthly premium based on your annual income.  You may also pay an additional annual deductible and coinsurance equaling 20% of the cost of your care.

For both Part A and Part B:

  • You generally pay a fixed deductible before Medicare pays its share. Only after that, will Medicare pay its share, and you will pay your share called a coinsurance or copayment.  There is no limit to out-of-pocket costs.
  • You can go to any doctor, health care provider, hospital or another healthcare facility that is enrolled with Medicare and accepts Medicare beneficiaries.
  • You can seek medical care without referrals in most cases. The specialist, however, has to be enrolled with Medicare.
  • You can file Medicare claims for the covered services and supplies through providers, like doctors, hospital, skilled nursing facilities, and home health agencies, and suppliers.

For detailed information on coverage and cost associated with Original Medicare, you can explore Medicare Plans at https://www.medicare.gov/, or https://www.medigap.org/.

Sources:

https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html

http://www.nydailynews.com/life-style/health/medicare-guide-original-medicare-covers-80-part-b-article-1.2436004

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