What is Original Medicare?

Medicare is a federal health insurance program for the elderly (65 and older), disabled individuals under age 65, and beneficiaries who have ALS or end-stage renal disease. Medicaid beneficiaries may also enroll in Original Medicare or Medicare Advantage programs. Individuals become eligible for Original Medicare at age 65 if they or their spouse have worked and paid Medicare taxes for a certain period of time. Some individuals may also qualify for Medicare earlier due to disability or certain medical conditions.

Original Medicare covers only Part A and Part B benefits. An individual's income is not taken into account when determining eligibility for Medicare. However, depending on their income, some people may have to pay higher rates. Medicare Part B Income-Related Monthly Adjustment Amounts Higher-income earners may have to pay higher premiums. Lower income Beneficiaries may be eligible for financial aid to help pay premiums and services.

Original Medicare refers to the traditional fee-for-service healthcare coverage provided by the federal government through the Medicare program. Original Medicare consists of two main parts:

1. Hospital Insurance Benefits" (hospitalization): is how Part A is referred to. Other inpatient care, such as that provided in skilled nursing institutions, rehabilitation centers, and hospices, is also covered under Part A
2. Medicare Part A (Hospital Insurance): Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare services. Most people do not have to pay a premium for Part A if they or their spouse paid Medicare taxes while working. However, there are deductibles, coinsurance, and copayments associated with Part A services
3. Medical Insurance Benefits or Medical Provider Services are what are covered under Medicare Part B. Part B includes a wide range of outpatient services, including medical treatment, medications that are given by doctors or other medical professionals (such as vaccines and intravenous medications) while in the hospital. Services Part B may not cover This is the part of Medicare that actually charges a monthly premium
4. Medicare Part B (Medical Insurance): Part B helps cover medically necessary services and supplies, including doctor visits, outpatient care, preventive services, and durable medical equipment. Medicare Part B Coverage Part B requires the payment of a monthly premium, which is typically deducted from Social Security benefits. Beneficiaries are also responsible for deductibles, coinsurance, and copayments for Part B services.

Original Medicare allows beneficiaries to receive healthcare services from any healthcare provider, hospital, or facility that accepts Medicare. It provides coverage nationwide and is not limited to specific networks or service areas.

What Does Original Medicare Cover?

While Original Medicare covers a significant portion of healthcare costs, it doesn't cover all expenses. There may be out-of-pocket costs, such as deductibles, coinsurance, and copayments, which beneficiaries are responsible for paying. To help with these costs and fill in the gaps in coverage, individuals can choose to enroll in additional coverage options, such as Medicare Supplement Insurance (Medigap) plans or stand-alone Medicare Part D prescription drug plans.

It's important to note that Original Medicare does not typically include coverage for prescription drugs (except in limited circumstances under Part B) or other additional benefits such as dental, vision, or hearing services. However, beneficiaries have the option to obtain these coverages through separate plans, such as Medicare Part D prescription drug plans or Medicare Advantage (Part C) plans that may include additional ancillary benefits.

Low-income beneficiaries might also be eligible for additional help through the individual state programs where they live. State and federal Low Subsidies (LIS) and Extra Help Resources may be available to lower-income beneficiaries to help pay for Parts B and D premiums.

Potential and current beneficiaries have options for receiving their Medicare Part A hospitalization coverage, Part B medical services coverage, and Part D prescription drug coverage:

• "Original Medicare, or Fee-for-Service Medicare", pays for services on a fee-for-service basis.
• "Hospital Insurance Benefits" is Part A. Other inpatient care, such as that provided in skilled nursing institutions, rehabilitation centers, and hospices, is also covered under Part A.
• Medicare Part B helps cover outpatient care, including visits to doctors' offices, preventive services, ambulance services, laboratory tests, durable medical equipment (such as wheelchairs or walkers), and some home health services. It also covers certain medications administered in an outpatient setting, such as injections.
• Beneficiaries can also get coverage through private health plans through their group employer insurance (even if they get their medical Part B coverage through Original Medicare).

Can You Get Medicare Part C With Original Medicare?

Medicare Advantage Part C (which is not original Medicare) is administered by private insurance companies. Advantage plans are required to provide Parts A and B with at least the same benefits as original Medicare. Advantage plans may have additional benefits. Benefit packages are different depending on the private insurance carrier. Hospice benefits may still be provided to Part C plan beneficiaries.

Is Medicare Part D included in Original Medicare?

Medicare Part D (prescription drugs) regulates Medicare prescription drug programs and provides coverage for prescription drug benefits. Part D Prescription Drug coverage Even though Part D is an option for Medicare Advantage Plans, unless you have other Creditable prescription drug coverage, Medicare Advantage plans typically provide this service.