Original Medicare (Hospital & Doctors Coverage)
Medicare is a federal health insurance program. Original Medicare consists of Part A and Part B. Whereas, Parts C and D are optional. Although, Part D covers prescriptions and if you don’t enroll when first eligible, you could be penalized. Eligibility begins with an individual turning 65, or after 24 months on disability (regardless of age) for a qualifying ailment.
Four Parts A, B, C & D
- Inpatient Part A covers hospitalization.
- Outpatient Part B covers medical expenses when you’re not in the hospital. This includes doctors, tests, outpatient surgery, home medical equipment, mental health treatment, and physical therapy. There are no provider networks with Part B. You can see any healthcare provider that accepts Medicare.
- Advantage Part C is a Medicare Advantage plan. It is an alternative to Original Medicare, offered through private insurance companies. Part C plans may be HMOs or PPOs and may offer additional benefits like a prescription, dental or vision coverage.
- Prescription Part D is prescription drug coverage.
Understand Medicare Premiums
Many people think that Original Medicare is free, but in fact, you’ll probably pay a monthly premium for your coverage. Although, Part A (hospitalization) is free for most people.
Most people pay a standard premium for Medicare Part B. However, you may pay more if your income is above a certain amount.
If you enroll in a Part C plan, you’ll still pay your Part B premium. You may also pay your insurance company an additional premium amount, depending on the plan you choose.
Part D premiums vary depending on your insurance company and your plan’s benefits. However, if your income is above a certain level, you will also pay an additional premium.
Original Medicare Benefits and Out of Pocket Costs 2019
Before deciding on coverage, you need to know what you’ll pay as well as where your benefits start and end.
Part A has a deductible of $1,364 in 2019. This deductible could be required multiple times throughout the year, depending on hospital admittance.
Also, you must pay a coinsurance of a few hundred dollars a day after your 60th day in the hospital. At some point after the 90th day, coverage runs out and you must pay all costs out of pocket.
The Part B deductible is $185 a year for 2019. After that, Original Medicare pays 80 percent of your medical costs.
Plan C replaces Medicare; so, when you enroll in a Medicare Advantage plan, you follow the insurance companies’ guidelines. Deductibles, co-pays and out of pocket costs depend on the state, the plan selected, and whether the doctors are in-network.
Prescription plans have out of pocket costs that vary, depending on the plan and the cost of the medication you take.
Part D drug plans are optional, and specific rules apply.
It’s important to understand that Part A & B does not cover all your medical expenses. If you choose to go with Part A, B, and C, you would want to add a Medicare Supplement plan to give you the most all-inclusive coverage & benefits.
Know Your Medicare Supplemental Coverage Options
By now you can see that Original Medicare won’t cover all your health care costs. However, supplement plans, also known as Medigap, can take care of things that Original Medicare doesn’t pay.
Medigap can offer coverage for things like deductibles, co-pays, and coinsurance.
Supplement plans are only available if you’re enrolled in Parts A and B. You can’t enroll in Medigap if you have Medicare Advantage plan.
Medigap is private insurance. Although the plans have a standard set of benefits, different companies may charge different premiums for the same coverage.
If you sign up for Medigap during the six-month enrollment window, you get Guarantee Issue coverage at the best premium.
When you sign up later or decide to change plans, coverage will be underwritten; this means you’re subjected to denial or higher premiums charged more because of preexisting conditions.
For more information on any of the plans listed above please call the number above. If you’re shopping for rates in your area you can fill out our compare rates form to see the rates side by side with the top carriers.