What Benefits Are Included in Original Medicare?

 

Original Medicare is a fee-for-service health insurance program for people 65 and older, people with certain disabilities, and people with end-stage renal disease (ESRD). It is the single largest health insurance program in the United States, covering over 60 million people.

Original Medicare has two parts: Part A and Part B.

Part A (Hospital Insurance) covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care.

• Inpatient hospital care: Part A covers up to 90 days of inpatient hospital care per benefit period. After 90 days, you are responsible for paying a daily coinsurance.
• Skilled nursing facility care: Part A covers up to 100 days of skilled nursing facility care per benefit period. After 100 days, you are responsible for paying a daily coinsurance.
• Home health care: Part A covers home health care if you are homebound and need skilled care.
• Hospice care: Part A covers hospice care if you are terminally ill.

Part B (Medical Insurance) covers doctor visits, outpatient care, preventive services, and some prescription drugs.

• Doctor visits: Part B covers doctor visits, but you are responsible for paying a copay.
• Outpatient care: Part B covers outpatient care, such as lab tests, x-rays, and surgery. You are responsible for paying a copay for most outpatient care.
• Preventive services: Part B covers preventive services, such as flu shots and colonoscopies. These services are free of charge.
• Prescription drugs: Part B covers some prescription drugs. However, you may have to pay a monthly premium and a copay for each prescription.

In addition to Part A and Part B, you can also purchase a Medicare Part D plan to cover prescription drugs.

Original Medicare has some gaps in coverage, so you may want to consider purchasing a Medicare supplement plan (Medigap) to help fill in those gaps. Medigap plans are sold by private insurance companies and can help pay for things like copays, deductibles, and out-of-pocket costs.

If you are considering original Medicare, it is important to understand the benefits and limitations of the program. You should also talk to your doctor and a Medicare insurance agent to help you choose the right coverage for your needs.