Original Medicare

Original Medicare

Original Medicare is a federal health insurance program in the United States that provides coverage for individuals who are 65 years old or older, as well as certain younger individuals with disabilities and those with end-stage renal disease (ESRD). It consists of two main parts: Medicare Part A and Medicare Part B. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Most people do not have to pay a premium for Part A if they or their spouse paid Medicare taxes while working. However, there are deductibles, coinsurance, and copayments associated with Part A services. Medicare Part B, also known as medical insurance, covers medically necessary services and supplies, including doctor visits, outpatient care, preventive services, and durable medical equipment. Part B requires a monthly premium, which is typically deducted from the individual's Social Security benefits. There are also deductibles, coinsurance, and copayments associated with Part B services. While Original Medicare provides coverage for a wide range of healthcare services, it does not cover all expenses. There are gaps in coverage, such as prescription drugs, routine dental and vision care, and long-term care. To help fill these gaps, individuals can choose to enroll in additional coverage, such as Medicare Part D prescription drug plans or Medicare Supplement Insurance (Medigap) plans. It's important to note that Original Medicare is administered by the federal government, and individuals have the freedom to choose their healthcare providers as long as they accept Medicare. However, it's advisable to check with providers to ensure they accept Medicare assignment, which means they agree to accept the Medicare-approved amount as full payment for covered services.

Some of the cost-sharing associated with the Original Medicare

Deductible

 Part A Deductible:

Part A covers hospital services, including inpatient care, skilled nursing facility care (under certain conditions), hospice care, and some home health care. The Part A deductible refers to the amount that beneficiaries must pay out of their own pocket before Medicare starts covering the costs. This deductible is applied per "benefit period," which begins when a beneficiary is admitted to the hospital or a skilled nursing facility. The benefit period ends when the beneficiary has not received any inpatient hospital or skilled nursing care for 60 consecutive days.


Part B Deductible:

Part B covers medical services such as doctor visits, outpatient care, preventive services, and durable medical equipment. The Part B deductible is the amount that beneficiaries must pay before Medicare starts paying its share for these services. Unlike the Part A deductible, which is applied per benefit period, the Part B deductible is an annual deductible.

  

Coinsurance

 Coinsurance is another important aspect of Original Medicare coverage. In addition to deductibles, beneficiaries may also encounter coinsurance costs when they receive medical services under Part A and Part B.


Part A Coinsurance:

Under Part A, beneficiaries are responsible for          paying coinsurance for certain types of inpatient      care. Once the Part A deductible (if applicable)        has been met for a benefit period, Medicare pays 80% of the approved amount for covered   services, and the beneficiary is responsible for the remaining 20% coinsurance amount.


Part B Coinsurance:

Part B of Original Medicare covers outpatient medical services, and beneficiaries are generally required to pay a coinsurance amount for these services. After the Part B deductible has been met (if applicable), Medicare typically covers 80% of the approved amount for covered services, and the beneficiary is responsible for the remaining 20% coinsurance.




 

Copay

Copay (or copayment) is another important aspect of Medicare coverage. It is a fixed amount that beneficiaries are required to pay for certain medical services and supplies covered by Medicare.


                       Part A Copay:

        For Part A, beneficiaries may have to pay   copayments for certain types of care received in    an inpatient setting, such as a hospital or skilled  nursing facility. As mentioned earlier, Part A has a       deductible, and once that deductible is met,   copayments may apply after a certain number of                 days in the hospital.


                              Part B Copay:

 Under Part B, beneficiaries may have copayments for various outpatient services, including doctor          visits, durable medical equipment, and other                     medical supplies.

 

What are the different types of Medicare enrollment periods ?

  • 1. Initial Enrollment Period (IEP)

    The Medicare Initial Election Period (IEP) is a seven-month window that begins three months before an individual turns 65, includes the birth month, and extends for three months afterward, during which they can enroll in Medicare Part A and Part B without incurring any late enrollment penalties.

  • 2. Initial Coverage Election Period (ICEP)

    The Initial Coverage Election Period (ICEP) is the period when you can enroll in a Medicare Advantage Plan for the first time. Your ICEP begins three months before you are enrolled in both Parts A and B and ends either the last day of the month before you are enrolled in both Parts A and B or the last day of your Part B initial enrollment period, whichever is later.

  • 3. Annual Enrollment Period (AEP)

    The Medicare Annual Election Period (AEP) is the specific timeframe from October 15th to December 7th each year, during which Medicare beneficiaries can make changes to their Medicare Advantage (Part C) and Medicare Part D prescription drug plans.

  • 4. Open Enrollment Period

    Medicare Advantage Open Enrollment Period (MA OEP):

    The Medicare Advantage Open Enrollment Period (MA OEP) takes place from January 1st to March 31st annually. During this period, individuals who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or return to Original Medicare (Part A and Part B). This enrollment change can only be done once during this period.

  • 5. Special Election Period

    The Medicare Special Election Period (SEP), is a designated period outside of the regular enrollment periods, during which eligible individuals can make changes to their Medicare plans, due to certain qualifying life events or special circumstances. It occurs every 3 months , during the first 3 quartes of the year.

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