Original Medicare

Original Medicare, often referred to as “Traditional Medicare” is a foundational healthcare plan offered by the federal government.  In the article, we’ll break down the essentials of Original Medicare to help you make informed decisions about your healthcare coverage.

Original Medicare is a government-sponsored health insurance plan that provides essential healthcare coverage to eligible individuals aged 65 and older, as well as certain individuals with disabilities.  It is composed of two main parts:  Part A and Part B.

    Medicare Part A:  Hospital Insurance

• Part A primarily covers inpatient care received in hospitals, skilled nursing facilities, hospices, and some home health care.
• This Coverage includes services such as hospital stays, skilled nursing facility care, hospice care and limited home healthcare services.
• Most people do not need to pay a premium for Part A coverage if they or their spouse paid Medicare taxes while working.  

    Medicare Part B:  Medical Insurance

• Part B covers outpatient care, including doctor visits, preventive services, and some home health care
• This coverage includes services like doctor visits, preventive care (like covid or flu shots and screenings), outpatient therapies, and durable medical equipment (like wheelchairs).
• Part B requires a monthly premium, which varies based on your income. 

How Does Original Medicare Work?

Original Medicare provides essential coverage for a wide range of healthcare services, but it doesn’t cover everything.  To fill in the gaps and add extra coverage, many people opt to enroll in additional plans, such as Medicare Supplement Insurance (Medigap) plans or Medicare Advantage (Part C).

• Medicare Supplement Insurance (Medigap):   Medigap plans are offered by private insurance companies.  They cover the “gaps” in Original Medicare, such as deductibles, copayments and coinsurance.  These plans allow you to see any doctor or specialist who accepts Medicare.  You DO NOT need a referral to see a specialist.  You only need to make sure they accept Medicare. 
  

• Medicare Advantage (Part C):  These plans are also offered by private insurance companies.  They include all benefits of Original Medicare (Parts A & B) and often provide additional benefits such as vision, dental, and prescription drug coverage.  Part C plans may have networks of doctors and hospitals you must use and can vary in terms of coverage and cost.  In general you will need a referral to see a specialist. 

What Original Medicare Doesn’t Cover:

While Original Medicare is comprehensive, it does not cover certain healthcare services that are essential for many individuals.  Some of these include:

• Prescription Drugs:  To get prescription drug coverage, you need to enroll in a Medicare Part D plan.
• Dental, Vision, and Hearing Care
• Long-Term Care: Custodial care in nursing homes and assisted living facilities is not covered by Original Medicare.
  

Enrollment and Costs

Enrolling in Original Medicare usually happens automatically if you’re already receiving Social Security Benefits.  If you are not, you can sign up during your Initial Enrollment Period (IEP) around your 65 birthday.  Keep in mind that there are specific enrollment periods for different parts of Medicare, and failing to enroll on time could lead to penalties.  

The costs associated with Original Medicare can include monthly premiums, deductibles, coinsurance, and copayments.  You will want some type of plan, either a Supplement or an Advantage plan to help cover these costs.

In Conclusion:

Original Medicare serves as a foundational health care plan for eligible individuals, covering essential hospital and medical services.  However, it's important to recognize that it doesn’t cover all healthcare needs.  To ensure comprehensive coverage, many individuals choose to supplement their Original Medicare with additional plans like Medicare Advantage or Medigap. Understanding your options and considering your healthcare needs are key to making the right choices for your well-being! 

To Get Help Now Call our office

Rob Davies
Prairie Grove Insurance
800-254-5200