What is Original Medicare?
Medicare is the health insurance program administered by the Federal Centers for Medicare and Medicaid Services (CMS). It is for people 65 years of age and older, people of any age with permanent kidney failure, and some disabled individuals under age 65. Although Medicare may pay a large part of your health care expenses, it does not pay for them all.
Medicare is divided into four parts of coverage- Part A and Part B (sometimes known as ‘Original Medicare’), Part C, and Part D. The following is an overview of these four parts.
Medicare Part A is commonly known as Hospitalization Insurance. For most people, Part A is premium-free. It pays for some of your hospital stay, certain skilled nursing facility expenses, limited rehabilitative services, some home health care, and hospice care. It does not pay for personal (custodial) care. Under Medicare Part A, you will pay a deductible before your Medicare benefit begins. If you enter the hospital, a benefit period starts. This benefit period ends when you have been out of the hospital for 60 consecutive days. If you are re-admitted within that 60 days, you are still in the same benefit period.
Medicare Part B is Medical Insurance. It covers expenses such as, doctors’ visits, lab tests, diagnostic tests, outpatient hospital care, physical and occupational therapy, and durable medical equipment. Part B has a monthly premium and also an annual deductible.
Medicare Part C is known as Medicare Advantage. It provides coverage through a private insurance company. You must have Medicare Parts A and B to get a Medicare Advantage Plan through an insurance company.
Medicare Part D is prescription drug insurance. Private insurance companies that are approved and contracted with Medicare offer this coverage. The cost of your Medicare Part D plan will vary among insurers. You will share in the costs of your prescription drugs according to the specific plan that you enrolled in. Those costs can include a deductible, a flat copay amount, or a percentage of the full drug cost (co-insurance). If you cannot afford the cost of your medications, you may qualify for Extra Help. For questions about eligibility for help with costs of Medicare coverage, call: 1.800.772.1213.
Your biggest decision is whether you want Medicare Part A and Part B, known as Original Medicare, or Medicare Part C, known as Medicare Advantage. Both choices cover the same basic services, but work very differently. What choice is right for me?
Which plan is right for you?
Medicare Part A & Medicare Part B (Original Medicare) You may choose to buy a Medicare Supplement (also called Medigap) policy through a private insurance company to help pay costs associated with Original Medicare. With this choice, you have a 6-month period called ‘Open Enrollment’, beginning with the date that you first enroll in Part B, where you cannot be denied insurance because of your medical conditions. You need to decide if you want a Part D Prescription Drug Plan through a private insurance company.
Medicare Part C (Advantage Plan) This plan is through a private insurance company. It combines services such as, doctor visits, outpatient surgery, lab tests and hospital stays. Most Advantage Plans include Part D Prescription Drug coverage.
*Additional Benefits Dental, vision and hearing benefits are sometimes included as well as a health club fitness membership at participating facilities. With this choice, you will have an Annual Enrollment Period from October 15th through December 7th each year. This period allows you to change your current Medicare Advantage Plan, Part D Prescription Drug Plan, or drop your Medicare Supplement Plan to join an Advantage Plan.