If you’re soon-to-be eligible for Medicare, you’re probably wondering what Original Medicare is. Whether you’re preparing to retire or about to celebrate your 65th birthday, you’ll need to make decisions about your Medicare soon. Not only are there dozens of plans and coverage types, but Medicare has unique terminology. Below, we provide you with the information needed to understand what Original Medicare is and how your benefits work.
What is Original Medicare?
Original Medicare provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services. Original Medicare is a fee-for-service plan that’s managed by the federal government.
Medicare Part A vs Part B
Part A is your inpatient coverage. So, a hospital visit or hospice care would fall under Part A. For many people, Part A is premium-free, but some pay for this coverage. The premium depends on how long you’ve contributed to Medicare taxes.
Medicare only covers 80% of Part A services after you’ve met the deductible. A new benefit period starts when you’ve been out of an inpatient facility for 60 days or more. Part B is the outpatient portion of Medicare. You’ll use Part B at doctors’ offices.
While Part A is premium-free, Part B has a monthly premium based on income. For outpatient services, Medicare covers 80% after you meet the annual deductible. The Part B deductible is a once-per-year amount.
What Are the Qualifications for Medicare?
If you’re turning 65 or have been on disability for at least 24 months, you’re likely eligible for Medicare. Those with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease may not need to wait 24 months for Medicare to start.
What is Medicare Part C?
When you choose a Medicare Advantage plan, a private company will handle your benefits and claims instead of the federal government. The policy must cover at least as much as Medicare. Unless you go out of the network.
Also, there are Health Maintenance Organization Point of Service policies that allow you to see some doctors out of network at a higher rate. The Private Fee for Service policies require you to call the doctor before services are rendered to ensure coverage is still available, you must do this EVERY time before an appointment. For those that have low-income or chronic issues, Medicare Advantage Special Needs plans can help. But, you must live in the service area of the plan to qualify.
What is Medicare Part D?
Medicare Part D prescription drug plans help lower the cost of prescriptions. Beneficiaries can pay copayments instead of paying the full price of prescribed medications. For over 40 years, beneficiaries had no options for retail prescription drug coverage. Medicare can be challenging to understand. Part D is no exception; here’s what you need to know!
