How does Original Medicare work?

3 min. readlast update: 10.17.2023

Original Medicare, also known as Medicare Parts A and B, is a federal health insurance program in the United States. It provides coverage for essential healthcare services to eligible individuals, primarily those aged 65 and older. Here's how Original Medicare works:

Medicare Part A (Hospital Insurance):

   - Hospital Coverage: Part A helps cover inpatient hospital care, including semi-private rooms, meals, nursing services, and necessary medications during your hospital stay.

   - Skilled Nursing Facility (SNF) Care: Part A also covers a limited amount of skilled nursing facility care following a hospital stay of at least three days.

   - Home Health Care: Part A covers medically necessary home health services, including skilled nursing care, physical therapy, and medical equipment, under certain conditions.

   - Hospice Care: Part A provides coverage for hospice care for individuals with a terminal illness, including pain relief, symptom management, and emotional support.

Medicare Part B (Medical Insurance):

   - Doctor Visits: Part B covers medically necessary services provided by doctors, specialists, and other healthcare providers, including outpatient care, preventive services, and diagnostic tests.

   - Medical Supplies and Equipment: Part B covers durable medical equipment (DME), such as wheelchairs, walkers, and oxygen equipment, when prescribed by a healthcare provider.

   - Laboratory Tests: Part B covers laboratory tests, such as blood work and diagnostic screenings.

   - Vaccinations: Part B covers certain vaccinations, including flu shots and vaccines to prevent diseases like pneumonia.

   - Outpatient Services: Part B covers a range of outpatient services, including ambulatory surgical procedures, mental health services, and rehabilitation therapies.

Costs and Coverage:

   - Premiums: Most people do not pay a premium for Medicare Part A (if they or their spouse paid Medicare taxes while working). Part B requires a monthly premium, the amount of which may vary based on income.

   - Deductibles and Coinsurance: Both Part A and Part B have annual deductibles and require beneficiaries to pay coinsurance or copayments for covered services. These costs may vary depending on the service and type of care received.

   - Coverage Limitations: It's important to note that Original Medicare does not cover certain services, such as prescription drugs (unless administered in a hospital or doctor's office), routine dental care, routine eye exams, and most long-term care.

Additional Coverage Options:

   - Prescription Drug Coverage (Part D): Medicare Part D offers prescription drug coverage, which is provided through private insurance companies. It helps pay for the cost of prescription medications.

   - Medicare Supplement (Medigap) Plans: These plans are offered by private insurance companies and can help cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance.

It's worth noting that Medicare beneficiaries have the option to receive their Medicare benefits through Medicare Advantage (Part C) plans, which are offered by private insurance companies approved by Medicare. These plans often provide additional benefits and may include prescription drug coverage.

Understanding how Original Medicare works can help you make informed decisions about your healthcare coverage. For personalized guidance and more detailed information, it's advisable to consult with the official Medicare website, speak with a licensed insurance agent, or contact Medicare directly.

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