Original Medicare was created in 1965, it has 2 Parts – Part A and Part B. Centers for Medicare and Medicaid oversees the program under Department of Health and Human Services. Payroll taxes, money from the general fund, and premiums paid by beneficiaries fund the program. It is a fee for service program. It has deductibles and coinsurance for medically necessary services.
Part A covers Hospital stays and related services, such as hospice, home health, inpatient mental stays, hospital related physician services.
Part B covers Medical services, such as doctor visits, outpatient procedures, emergency room visits, ambulances, and the list goes on.
What does Original Medicare cover?
- Outpatient services such as doctor visits, lab tests, emergency room visits, outpatient procedures
- Inpatient Hospital stays
- Healthcare inside the US and its territories
Preventative services, such as vaccines, and health screenings are covered under Original Medicare.
What doesn’t Original Medicare cover?
- Routine eye exams and glasses
- Routine hearing exams and hearing aids
- Routine dental exams, cleaning etc.
- Healthcare outside the US
- Long term Care or custodial care
Outpatient Prescription drugs – you can purchase a Part C plan to obtained prescription coverage.
Medicare Part C plans may cover some of the above items.
Is there a Medicare network? Any doctor or hospital that is contracted with Medicare will accept beneficiaries enrolled in Original Medicare.
Will I need a referral to see a specialist? No referral is needed to see a specialist under Original Medicare.
How much will I pay for Original Medicare?
If you (or your spouse) worked at least 40 quarters (or 10 years) your Part A for Original Medicare will be premium free. If you worked under 40 quarters, you can purchase Medicare Part A.
For Part B for most people there is a monthly premium deducted from social security benefits. This amount changes every year based up healthcare costs and the Cost of Living Adjustment – click to see the current amount . The Part B premium can also be higher for people in higher income brackets.
What out of pockets costs could I incur under Original Medicare?
As a rule, Medicare pays 80% of the contracted rate (see Medicare assignment ) after any applicable deductible. There is no maximum out of pocket limit for deductibles and coinsurance under Original Medicare.
Original Medicare is a good base, but it was never intended to be full coverage. See our Medicare Health plan options for information on how to maximize your Original Medicare benefits, protect yourself from unexpected healthcare costs and get coverage for additional benefits not covered under Original Medicare.