Original Medicare
How Does Original Medicare Work?
Original Medicare is one of your health coverage choices as part of Medicare. You’ll have Original Medicare unless you choose a Medicare Advantage Plan or other type of Medicare health plan. You generally have to pay a portion of the cost for each service covered by Original Medicare.
What services does Medicare cover?
- Medicare Part A and Part B cover certain medical services and supplies in hospitals, doctors’ offices, and other health care settings.
- Prescription drug coverage is provided through Medicare Part D.
Part A (Hospital Insurance) helps cover:
- Inpatient care in a hospital
- Inpatient care in a skilled nursing facility (not custodial or long-term care) •
- Hospice care
- Home health care
- Inpatient care in a religious nonmedical health care institution
Medicare Part B (Medical Insurance) helps cover:
- medically necessary doctors’ services
- outpatient care
- home health services
- durable medical equipment
- mental health services, and other medical services.
- Covers many preventive services.
Under Original Medicare, if the Part B deductible ($185 in 2019) applies, you must pay all costs (up to the Medicare-approved amount) until you meet the yearly Part B deductible. After your deductible is met, Medicare begins to pay its share and you typically pay 20% of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment. There’s no yearly limit for what you pay out-of-pocket.
How does Medicare prescription drug coverage (Part D) work?
- Medicare prescription drug coverage is an optional benefit.
- Medicare drug coverage is offered to everyone with Medicare.
- Even if you don’t use prescription drugs now, you should consider joining a Medicare drug plan.
- If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.
Original Medicare doesn’t cover include:
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Massage therapy
- Routine physical exams
- Acupuncture
- Hearing aids and exams for fitting them
- Long-term care
- Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
