Original Medicare (Part A and B): How it works – Eligibility and Enrollment

Original Medicare How it works Eligibility and Enrollment

Understanding Original Medicare and the parts that go with it can seem like a lot of information at first. But to understand how to get the most out of it, just a little research needs to be done. It is worth the time because Medicare provides excellent health coverage you can easily customize to fit your health needs and budget.

What is Original Medicare?

Medicare is a health insurance program of the federal government for people 65 years of age or older and for some young persons with disabilities or health issue conditions.

In other words, original Medicare is coverage managed by the federal government. Generally, there is a decided cost for each service. It is a fee-for-service health plan with two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

Original Medicare gives you the opportunity to go for any doctor in the U.S. that takes Medicare, but it often comes with a high cost and does not include your medications.

To help combat this, many people decide to supplement original Medicare by adding one or more extras, expanding their coverage to help pay for these costs. Others choose to go the completely different route and enroll in the Medicare Advantage plan (also called Medicare Part C). The plan replaces Medicare Part A and Part B but provides all the services involved in both and acts like the private health insurance you receive through an employer.

The Center for Medicare and Medicaid Services (CMS) offers Original Medicare, also known as Medicare Part A and Part B. However, many people find that they need more coverage than original Medicare. For example, you may want dental, vision, and hearing insurance as well as prescription drug coverage. Here Medicare Part C and Part D play a vital role.

Original Medicare costs and coverage

Original Medicare has specific rules about what services it can cover and what it does not. For instance, home health care services are only covered in particular circumstances for those in need of specific treatments. Likewise, original Medicare does not cover hearing services and routine dental cures.

Medicare Part B includes several preventive services to help seniors and disabled adults stay healthy. These include annual health visits, cancer screening, vaccines, and testing and management of chronic conditions. All people with original Medicare have costs such as premiums, repayments, and deductibles. For physically disabled adults and senior citizens who have limited income, Medicare savings programs can help pay for original Medicare costs.

How Original Medicare works

Let’s understand with the help of some FAQs:

1. Are prescription drugs covered?

Only in limited situations, such as when you are hospitalized. When you join original Medicare, you can add comprehensive drug coverage by joining the Medicare Prescription Drug Plan (Medicare Part D).

2 Can I get my health care from any hospital or doctor?

Yes. You can go to any hospital, doctor, supplier, or any other facility enrolled in Medicare and accept new Medicare patients.

3. Do you have to get a referral to see a specialist?

No. You don’t need any referrals.

4. Do you need a supplemental policy?

You can select a Medicare Supplement Insurance (Medigap) plan, which helps cover costs that basic Medicare does not cover, such as coinsurance, copayments, and deductibles. Or you may already have union coverage or an employer that covers these costs.

What else do you need to know about Original Medicare?

Each year before Medicare pays its share; you usually have to pay a set amount (deductible) for your health care. Then, it pays its share, and you pay your share for the services and supplies covered. By having Medicare Part A, you can usually get the services associated with Part A. If you have Medicare Part B, you can usually get the services associated with Part B. 

You usually have to pay a monthly premium for Medicare Part B. You do not usually need to file a Medicare claim. Providers (such as doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers are required by law to file Medicare claims for the covered services and supplies you receive.

When you newly join Medicare Part A and B, Social Security automatically enrolls you in original Medicare. If you want to receive your care from a private Medicare Advantage plan, such as an HMO or PPO, rather than the original program, then you must actively enroll in the plan offered in your area. If you want to stay in Original Medicare, you can get prescription drug coverage by joining a private Part D plan for an additional premium. And you can also choose to purchase private supplemental insurance (also known as Medigap) to cover some of your out-of-pocket costs in the original program.

What will your costs be in Original Medicare?

Your costing may vary depending on the type of health care services you use and how often you need them. However, in general, your costing in original Medicare may include:

  • Monthly Premium for Medicare Part B*
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Coinsurance or copayments cost

*As noted, Medicare Part A is free if you have worked under Medicare-covered employment for at least ten years or 40 quarters. Otherwise, you also can sign up for Medicare Part A and pay a monthly premium for it, which will vary depending on the number of work quarters you have.

It is important to note that there is no annual spending limit in original Medicare, which means that there is no maximum limit, no matter how high your health care costs are each year.

Remember that your costs may vary, depending on what kind of services you need, how often you receive them, and other factors. 

What Else Does Medicare Advantage Cover?

It depends on the exact plan you choose, but in addition to being covered by Medicare Part A and Part B, many Medicare Advantages may also include:

  • International Travel Health Insurance for emergency care.
  • Prescription drugs
  • Gym membership discounts
  • 24 Hour Nurse Hotline

You should always consult your doctor regarding the diagnosis or treatment of a health condition, including decisions about the proper medication, as well as any specific exercise or dietary routine.

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