What is Original Medicare?

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What is Original Medicare?

 

You’re eligible for Medicare if you’re 65 and entitled to Social Security benefits or younger than 65, disabled, and entitled to Social Security benefits.Original Medicare is a federal health insurance program. It has two components:Medicare Part A (hospital care) and Medicare Part B (doctors visits and other outpatient care). You’re eligible for Medicare if you’re 65 and entitled to Social Security benefits, or younger than 65, disabled, and entitled to Social Security benefits.

Medicare Part A Provides Hospital Coverage

Medicare Part A helps cover inpatient care in hospitals and skilled nursing facilities, hospice care and home health care. Covered expenses include:

  • Semi-private rooms
  • Meals
  • Drugs
  • Medical supplies and equipment
  • Care on special units, such as intensive care

Part A also covers X-rays, labs, inpatient radiation treatment, operating room and recovery room services, blood transfusions, and rehabilitation services.

Hospital stays are limited to 90 days and skilled home nursing is limited to part-time care. For most people, Medicare Part A does not require a premium.

Medicare Part B Provides Medical Coverage

Medicare Part B helps cover medically-necessary services and some preventive services like flu and pneumonia shots. Medically-necessary services are any services required to diagnose and treat a condition. Examples include:

  • Inpatient and outpatient doctor services
  • Outpatient care
  • Home health services
  • Ambulatory surgery center services
  • Emergency room services

Other covered expenses may include lab services, X-rays, scans, EKGs, some diagnostic tests, durable medical equipment for use at home, and skilled nursing and health aid services for the homebound. Medicare Part B requires a premium—usually about $115 per month.

Additional Medicare Coverage Choices

There are some health care benefits that are not covered by Original Medicare. This includes hospital stays over a certain period in length and help with activities of daily living such as eating, bathing or dressing. Prescription drugs are also not covered under Original Medicare. Some of these benefits can be added by buying a Medicare prescription drug plan (Part D) or a Medicare Supplement Insurance plan, available through private insurance companies.

Medicare prescription drug coverage (Part D) is optional, but if you don’t sign up when you become eligible you could pay a higher premium for it later. Coverage terms vary, and plans offer various levels of cost sharing until you reach a specified amount in a year. Some plans have a deductible and some don’t. Others charge a copay or coinsurance, which is a percentage of the cost of prescriptions.

Medicare Supplement Insurance plans, also known as Medigap, help pay for some of the costs that Medicare Parts A and B don’t cover. This includes extended hospital stays, deductibles and copays. Plan benefits are defined by the federal government into standardized feature sets, but prices vary.

If you have or are considering Original Medicare, you may want to look into the additional coverage that prescription drug plans and Medicare Supplement Insurance Plans offer.

To learn more, contact UnitedHealthcare® Medicare Made Clear at 1-877-619-5582 (TTY 711), 8 a.m. - 8 p.m., 7 days a week. You may also call the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

Resources:

Understanding Medicare

Prescription Drug Coverage

Medicare Supplement Insurance Plans

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