| Thu, Jun 20, 2019 @ 10:59 AM

What is Original Medicare?

Posted by Medicare Made Clear

how-does-original-medicare-help-seniorsOriginal Medicare a federal health insurance program for Americans aged 65 and older and others with qualifying disabilities. It has two parts – Part A and Part B. Each part covers specific health care services.

Medicare Part A

Medicare Part A covers inpatient care. This is care you receive when you are admitted to a hospital or skilled nursing facility. In general, Part A coverage includes:

  • A semi-private room
  • Hospital meals
  • Skilled nursing services
  • Lab tests and X-rays
  • Drugs, medical equipment and supplies used during your stay
  • Operating room and recovery room services
  • Care on special units, like intensive care
  • Rehab services after discharge, when qualified
  • Hospice care

Part A does not cover personal care services in the hospital, such as help with eating, bathing or dressing. Comfort items, such a phone or TV also are not covered.

Medicare manages Part A coverage and costs based on a “benefit period.” A benefit period begins the day you are admitted to a hospital or skilled nursing facility. It ends when you have been out of the hospital or facility for 60 days in a row.

Part A charges a deductible for each benefit period. After that, Part A covers most costs for up to a 60-day inpatient stay. If you’re in the hospital for longer than 60 days, you may pay a larger share of the cost. The deductible is $1,364 per benefit period in 2019.

One benefit period – and one deductible – may span two or more inpatient stays. If you’re discharged from the hospital or skilled nursing facility and readmitted within 60 days, it’s still the same benefit period and covered under the same deductible. A new benefit period begins only after you’re out of the hospital for 60 days in a row.

Most people get Medicare Part A with no monthly premium. You will not pay a premium if you or your spouse contributed to Medicare through payroll deductions for at least 10 years.

Medicare Part B

Medicare Part B covers doctor services and outpatient care. Outpatient care includes services you receive in a doctor’s office, a retail clinic, urgent care, or the emergency room. In general, Part B coverage includes:

  • Doctor services, even when you’re in the hospital
  • Some preventive services
  • Clinical lab services
  • X-rays, MRIs, CT scans, EKGs and some other medically necessary tests
  • Outpatient surgery services
  • Ambulance services
  • Outpatient mental health care
  • Durable medical equipment (wheelchair, walker, etc.)

Medicare Part B charges a monthly premium based on your yearly income. Most people pay the standard premium ($135.50 in 2019). People with higher incomes may pay up to $460.50 per month in 2019.

Other Part B costs include an annual deductible ($185 in 2019) and a 20 percent coinsurance for most Part B services.

Additional Coverage

Original Medicare (Parts A & B) doesn’t cover all your health care costs – and it doesn’t cover prescription drugs. If you want more coverage, you can add a Medicare prescription drug plan (Part D) and Medicare supplement insurance to Original Medicare.

Medicare Advantage is another option. Medicare Advantage plans (Part C) provide Part A and Part B coverage. Most plans also include drug coverage and offer extra benefits such as dental, vision and hearing care – all in one plan.

Medicare Advantage plans, Medicare prescription drug plans and Medicare supplement insurance are offered through private insurance companies approved by Medicare. You can find plans offered where you live at Medicare.gov.

For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.