Original Medicare is a program that provides completely free medical care to persons aged 65 and older. Eligible persons include U.S. citizens, legal alien permanent residents, and eligible non-citizen nationals (Lawful Permanent Residents (LPRs) and refugees).
As such, it provides important health coverage for many Americans. However, it does not provide all the medical benefits available in the United States. Eligible persons must enroll in Original Medicare (Parts A and B). Enrollment can be done online or by phone, but not in person. Before signing up, beneficiaries should first check their eligibility for Original Medicare.
Medicare part A
Part A of Original Medicare is the hospital part of the program. It covers inpatient hospital services, including inpatient nursing care, laboratory services, diagnostic services for physical or mental conditions, and office visits. This part of Original Medicare does not cover drugs.
It also covers care in skilled nursing facilities, hospice, and home health care. Medicare Part A has a set of rules beneficiaries must follow when receiving Inpatient hospital services, including deductibles and coinsurance amounts.
Beneficiaries are responsible for the deductible amount up front. It is followed by coinsurance – 20% per day for days 1-60 of an eligible inpatient stay in a hospital or facility that accepts it as payment.
What are the benefits of Part A?
Part A benefits include hospital services (inpatient and outpatient), nursing home care, laboratory services, X-ray services, and physician services. These benefits must be paid directly by the patient to the medical facility. As such, beneficiaries should check with their physician if any of these costs are not already covered by their health insurance plan (e.g., out-of-pocket cost).
In addition, Part A may also cover immunizations, preventive care, and certain medical equipment. There is also a program known as Part D, available for beneficiaries to receive prescription drug coverage. While some beneficiaries may be paying an additional premium for prescription drugs, it is important to know coverage varies by plan.
Finally, Part A provides help with travel costs when traveling outside of the United States for medically necessary treatments or services. While the cost varies by state, this can be helpful for Medicare beneficiaries who may not otherwise be able to afford medical treatments.
What are the limits on Part A?
Other than the deductible, there are no limits to the hospital services covered by Part A. Outpatient prescription drug costs, however, have a cost limit for inpatient admissions. The cap is 100 days of the drug cost per calendar year.
Beneficiaries should also be aware of the three-day skilled nursing facility stay rule. This rule states that the first hospital stay must last at least three consecutive days to have coverage for a related post-hospital skilled nursing facility costs.
Medicare Part B
Part B of Original Medicare covers physician services, outpatient hospital services, and other services such as lab tests and preventive care. It also covers durable medical equipment (including wheelchairs), ambulance service, and certain preventative healthcare (such as flu shots). Part B is optional. Enrollment only takes place if a beneficiary wants this coverage.
With Part B, the Premium amount varies according to the income bracket of the beneficiary. All enrolled persons are required to pay a monthly premium for Part B services (other than those with Low Income Subsidy assistance), as well as any applicable Deductible Amount. Services are not covered at 100%, and the beneficiary is liable for a coinsurance amount if applicable.
What Are the Benefits of Part B?
Part B provides medical services from a variety of providers. These include doctors, chiropractors, surgeons, physical therapists, optometrists, podiatrists, dentists, and many other practitioners. Beneficiaries must receive these services from eligible practitioners who are members of Medicare’s provider network.
Part B covers outpatient hospital services, including emergency room services. It also covers medically necessary preventive care (including physical exams), as well as certain diagnostic tests and mental health services. In addition, Part B provides coverage for in-home health care, along with some admittance to skilled nursing facilities and hospice care.
What Are the Limits on Part B?
There are no limits to the coverage provided by Part B, but beneficiaries can pay a monthly premium or utilization review fee. It is commonly known as the “Part B deductible” and is equivalent to 1% of their monthly income. Additionally, beneficiaries must pay 20% of their total Medicare cost for many services (such as home health services). There are also co-pays for certain services (like the Part B deductible, medical supplies, and home health services).
Additionally, beneficiaries are responsible for any out-of-pocket costs associated with co-pays or coinsurance amounts that exceed $250, and hospital stays must last at least three consecutive days.
Supplemental Coverage
Many Americans choose to purchase supplementary coverage from private insurers. These plans can provide prescription drug benefits and other supplemental benefits not covered by Original Medicare. However, these must be bought separately and paid for out-of-pocket. Because these plans must be purchased separately, beneficiaries should research all their options and compare costs before making a final decision.
While Original Medicare can provide important health coverage for many Americans, it does not cover every medical need. Supplemental coverage from private insurers may be a good option if beneficiaries are looking to fill in the gaps and receive more comprehensive coverage. Ultimately, any decisions about supplemental coverage should be made with careful consideration, research, and comparison.
Medicare Advantage Is an Alternative to Original Medicare
Medicare Advantage is a private alternative to Original Medicare notes specialist from www.clearmatchmedicare.com. Enrolment in Medicare Advantage must be done online or by phone, but not in person. Beneficiaries can choose between five different options. They will pay the monthly premium on the part of their Original Medicare that they keep after meeting their Part A deductible. They can also purchase supplemental coverage from Medicare Advantage plans.
Medicare Advantage plans may provide services and benefits that are not available under Original Medicare, such as dental care, vision care, hearing aid coverage, over-the-counter drug benefits, and even health club memberships. However, these benefits will vary by plan.
Although Medicare Advantage plans may provide additional coverage that is not available through Original Medicare, they also have limits and restrictions beneficiaries should be aware of before selecting a plan. Beneficiaries should compare the coverage, cost, and restrictions offered in each plan before signing up.
How Do I Enroll?
Enrolment in Original Medicare is a simple process that can be completed online or by phone. Before signing up, beneficiaries should first check their eligibility for Original Medicare. Beneficiaries can check their eligibility by entering their personal information on the Social Security website, including birth date and social security number.
Once eligibility is confirmed, enrolling in Original Medicare is done either at the Social Security office or by phone. After completing the enrolment form and mailing it to the Social Security office (or submitting it over the phone), beneficiaries will shortly receive information about their coverage and their Medicare cards.
To enroll in a Medicare Advantage plan, beneficiaries must first be enrolled in Original Medicare (Parts A and B). After selecting the plan they wish to join, enrolment can take place by submitting the application form either directly to the plan or to the Social Security office. Once enrolled, beneficiaries will gain access to their planned benefits and coverage.
Conclusion
Private insurers provide complementary medicine to Original Medicare; however, the complete form of healthcare available is provided by Original Medicare. With few exceptions, most medications are not covered by Original Medicare, so beneficiaries who want to take prescription drugs or have other medical needs that Original Medicare does not cover must buy supplementary coverage from a private insurer.
When deciding which type of coverage to receive, beneficiaries should compare their options, evaluate cost and coverage benefits and make informed decisions about the plan that best meets their personal needs. Regardless of the plan chosen, all persons aged 65 or over are eligible for Original Medicare and should carefully consider their coverage options.
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