Original Medicare refers to the traditional government-run health insurance program for individuals aged 65 and older, as well as certain younger individuals with qualifying disabilities. It is the foundational form of Medicare coverage provided directly by the federal government. Original Medicare consists of two main parts:
Medicare Part A (Hospital Insurance):
- Part A primarily covers inpatient hospital care. This includes stays in hospitals, skilled nursing facilities, hospice care, and some home health care services.
- Beneficiaries are generally not required to pay a monthly premium for Part A if they or their spouse have paid Medicare payroll taxes for a sufficient period while working.
Medicare Part B (Medical Insurance):
- Part B covers outpatient care, preventive services, doctor visits, and other medically necessary services that are not covered by Part A. This includes services provided by doctors, outpatient clinics, and some home health care services.
- Beneficiaries are required to pay a monthly premium for Part B, and the amount is based on their income.
Original Medicare is considered a fee-for-service program, meaning that beneficiaries can choose their healthcare providers, including doctors and hospitals, without restrictions, as long as the providers accept Medicare assignment. Medicare pays a predetermined amount for covered services, and beneficiaries are responsible for paying their share of the costs, including deductibles, copayments, and coinsurance.
While Original Medicare provides essential coverage, it may not cover all healthcare expenses. To address the gaps in coverage and provide additional benefits, some individuals choose to supplement their Original Medicare coverage with private insurance plans, such as Medicare Supplement Insurance (Medigap) policies and/or Medicare Part D prescription drug plans.
It’s important for Medicare beneficiaries to understand the components of Original Medicare and explore additional coverage options to ensure comprehensive and tailored healthcare coverage based on their individual needs.