Medicare, also known as “Original Medicare,” is a program launched in 1965 to provide health Insurance coverage for US citizens and legal residents aged 65 or older, or younger people with certain disabilities and those with End Stage Renal Disease.
Original Medicare comes in 2 parts:
In general, Part A (Hospital Insurance) covers:
- Impatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient that’s not custodial or long-term care)
- Hospice Care
- Home Health Care
In general, Part B (Medical Insurance) covers:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. In example, Physicians visits, durable equipment, lab and diagnostic tests and Chemotherapy (as an outpatient) are among the services that fall under Part B
- Preventative Services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is most likely to work best.
Do I need to choose a primary care doctor?
No, in Original Medicare you don’t need to choose a primary care doctor.
Do I have to get a referral to see a specialist?
In most cases, no. In Original Medicare, you don’t need a referral, but the specialist must be enrolled in Medicare.
Are prescriptions covered in Original Medicare?
Most prescriptions aren’t covered in Original Medicare. If you want prescription drug coverage with Original Medicare, in most cases, you will need to actively choose and join a stand-alone Medicare private drug plan (PDP) (Part D plan).
Some additional points about Original Medicare
- You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There’s no annual limit for what you pay out-of-pocket.
- You usually pay a monthly premium for Part B, and some may pay for Part A
It is important to understand your additional Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care.
Contact
MediSmart Advisors
Boca Raton Phone: (561) 900-7046