The Ultimate Guide to Original Medicare

Medicare Guide 2021

Medicare is a federal health insurance program offered by the Centers for Medicare and Medicaid Services (CMS). Medicare is comprehensive and flexible. This flexibility means that it is often confusing. Reading our ultimate guide below to understand Original Medicare. Although Original Medicare in better detail.

What is Original Medicare?

Original Medicare is Government health program design mostly for seniors and those on disability.

How Do I Qualify for Original Medicare?

To qualify for Medicare you need to have worked at least forty quarters in the U.S. and be 65 or over. You can also qualify if you have been on Social Security disability for 2 years.

How Much Does Original Medicare Cost?

There is generally no cost for Medicare Part A. There is a monthly premium for Medicare Part B that is income adjusted. The base premium is $148.50 in 2021.

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The “Original” in Original Medicare

When you hear people talk about Medicare, they’ll often talk about three things: Original Medicare, Medicare Advantage Plans, and Medicare Supplement Plans. It’s important to understand the different terminology. Original Medicare  is called “original” because it’s the basis for Medicare. There are two main parts to Original Medicare: Medicare Parts A and B. These are the parts of Medicare that most people are enrolled in. They cover inpatient/hospital care and outpatient services respectively. Medicare Supplement Plans are private gap policies sold by different insurance companies to decrease out-of-pocket expenses of Original Medicare.

Medicare Supplement Plans, also called Medigap policies, can only be paired with Original Medicare.

Medicare Advantage Plans are completely different from Original Medicare. They are a private alternative to Original Medicare. These are plans offered by private insurers. They often add different bonuses, like dental insurance or prescription drug coverage.

Once your Medicare is set up, You will receive your red, white, and blue card in the mail. It is important to understand that if you lose it you need to get a Medicare replacement card. You can call 1-800-medicare.

Medicare Part A

Part A is the first part of Original Medicare. It is the mandatory portion that everyone is enrolled in automatically when they enroll in Medicare. It pays for things you require in the hospital/inpatient care. Specifically, it covers:

 

  • Inpatient care
  • Skilled Nursing Facility
  • Hospice Care
  • Some Home Health Care

Provided that you have paid 40 quarters in taxes (10 years), Part A is free. It does not have a monthly premium if you meet the tax requirements. The specific costs of room and board” while you are hospitalized as an inpatient. This means that Medicare Part A are broken down below.

 

Monthly premium = $0*

Annual Deductible: $1408 for each benefit period (60-day window) Day 1-60 Coinsurance: $0

Days 61-90: $352 per day

Day 91 and after: $704 per day

Medicare Part B

As Part A’s counterpart, Part B covers outpatient services. Specifically, it covers outpatient services, preventive care, tests, and equipment. A full list of services covered by Centers for Medicare and Medicaid Services. Also known as CMS.

Both Medicare Part A and Part B is below.

Preventive Services

  • Counseling & Education
    • Alcohol misuse counseling
    • Cardiovascular disease behavioral therapy
    • Diabetes
    • Medical nutrition in patients with renal disease
    • Obesity
    • Smoking cessation
  • Screenings for:
    • Abdominal aortic aneurysm for at-risk patients
    • Alcohol misuse screening
    • Breast Cancer Screening
    • Cardiovascular disease Screening
    • Cervical and Vaginal cancer
    • Colorectal cancer
    • Depression
    • Diabetes
    • Glaucoma
    • Hepatitis B
    • Hepatitis C
    • HIV
    • Lung Cancer
    • Obesity
    • Osteoporosis via Bone Density tests
    • Prostate Cancer
  • Vaccines

Outpatient Services

  • Advance Care Planning
  • Ambulance services
  • Ambulatory surgical centers
  • Behavioral health integration services
  • Cardiac rehabilitation programs
  • Chemotherapy
  • Chiropractic services (if medically necessary)
  • Chronic care management services
  • Clinical research studies
  • Doctor and healthcare provider services
  • Emergency Department Services
  • Federally qualified health center services
  • Foot exams
  • Home Health Services
  • Kidney disease education
  • Mental Health Outpatient Services
  • Occupational and Physical therapy
  • Opioid use disorder treatment services
  • Outpatient hospital services
  • (Limited) Prescription drug coverage
  • Pulmonary Rehabilitation
  • Rural Health Clinic Services
  • Sexually Transmitted Infection screening and counseling
  • Speech-language pathology services
  • Telehealth
  • Transitional care management
  • Transplants and immunosuppressive drugs
  • Travel health needs
  • Urgently needed care

Tests

Equipment

  • Continuous Positive Airway Pressure therapy
  • Defibrillator
  • Diabetes equipment, including supplies and shoes
  • Durable medical equipment
  • Eyeglasses after cataract surgery
  • Kidney Dialysis and supplies
  • Prosthetics and Orthotics
  • Surgical dressings

Part B is not free. Part B costs include a monthly premium, a yearly deductible, and the remaining out-of-pocket expenses. However, keep in mind that these costs are also income dependent. If your income is high, expect to pay more than the numbers listed below.

Monthly premium (2021): $144.60 Deductible: $202.

 

After you meet the deductible, Medicare covers 80% of the cost and you have to pay the remaining 20%. Unfortunately, there’s no limit on your out-of-pocket expenses with Part B on Original Medicare.

It's important to understand the different parts of Medicare and what they cover. I'm hapy to help with any questions!
Keith Armbrecht
Medicare on Video

Role of Medicare Supplements

As you can imagine, out-of-pocket expenses can begin to add up very quickly with Medicare Part B. Medicare Supplement Plans can target these out-of-pocket costs to decrease the cost to the patient. For example, if you are expected to pay 20% of your $5,000 outpatient testing/equipment bill, if you didn’t have a Medicare Supplement Plan, you would be liable for $1,000. With a supplement plan, you may not have to pay anything at all.

What About the Other Parts of Medicare?

You may have also heard of Medicare Parts C and D. Part C is just another name for Medicare Advantage Plans. Remember, Medicare Advantage Plans are private health insurance plans sold as an alternative to Original Medicare. Part D is a prescription drug coverage plan. This is an optional addition to Original Medicare. There are other ways of securing prescription drug coverage, so not everyone needs Part D. Talk to an agent to figure out which plans are right for you.

Still Have Medicare Questions?

Original Medicare covers inpatient and outpatient healthcare services. Part A is mandatory but is free if you meet the tax requirements. Part B has a monthly premium and a deductible. You are expected to pay for a certain portion of the bill out-of-pocket unless you have supplement insurance. To learn more about your coverage options for Medicare, Medicare Advantage, and Medicare Supplement Plans, calls us at Medicare on Video today.

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