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How Does Original Medicare Work?

Posted by Bobby Brown on March 28, 2023 - 10:13am Edited 3/28 at 10:13am


 

Under Original Medicare, you get your benefits directly from the federal government. Original Medicare benefits include two parts, Part A and Part B, that provide your hospital and medical insurance. If you have a qualifying work history, your Part A benefits are premium-free.

Medicare Part B premiums are set each year by the federal government and most people pay the same standard rate. Some high earners (fewer than 5%) pay an income-related adjustment in addition to the standard Part B premium.

Because Original Medicare is managed by the federal government, the benefits are exactly the same for every person who enrolls. There are no pre-existing condition limitations or waiting periods.

Part A covers inpatient care when you are admitted to a hospital or skilled nursing home. It also covers hospice care and certain kinds of home health care. Part B pays for outpatient expenses like doctor visits, x-rays, and lab tests. It also covers durable medical equipment like wheelchairs and home oxygen supplies.

Under Original Medicare benefits, you can use any healthcare provider who accepts Medicare. This includes nearly 900,000 physicians nationwide. There are no networks. You pay the same amount for covered services from any of these providers, no matter which one you choose for your medical care.

There is no coverage for prescription drugs under Original Medicare, but you can enroll in a private Part D plan. Think of this as a pharmacy card. Part D Prescription Drug Plans are offered by private insurance companies that agree to provide at least the minimum benefits required by Original Medicare.