Original Medicare Plan

Medicare Parts A and B provide standard hospital and medical coverage.

  • Original Medicare covers most of your loved one’s medically necessary hospital bills and doctor’s fees.
  • Vision, dental, and hearing care, routine checkups, and outpatient prescription drugs are not covered by Original Medicare.
  • Original Medicare typically covers 80 percent of approved expenses provided by participating providers. Your loved one is responsible for the rest.

Next Step

Offered by private insurance companies, a wide range of Medigap plans fill common gaps in Original Medicare coverage.

Learn more

Original Medicare consists of Part A hospital coverage and Part B medical coverage. Part A covers most hospital bills and hospice care. Part B covers most doctor’s fees, medical equipment, diagnostics, outpatient care, and some rehabilitative therapy. Original Medicare does not cover custodial or long term care such as assistance with activities of daily living.

Who is eligible for Medicare?

  • Anyone 65 years old or older who is eligible to receive Social Security
  • An individual who is permanently disabled and has received Social Security Disability Insurance for 24 months
  • An individual receiving dialysis or awaiting a transplant for permanent kidney failure
  • An individual diagnosed with ALS (Lou Gehrig’s Disease)

What if a doctor doesn’t take Medicare?

Over 70 percent of doctors in the United States (not including pediatricians and other specialized physicians) have “accepted assignment” with Medicare. These providers, also known as participating physicians, bill Medicare directly at Medicare’s approved rate.

Find a Medicare Doctor

To find a Medicare participating physician in your city or state, visit the Medicare website.

Providers that don’t accept assignment can charge your loved one up to 15 percent more than the approved amount. For example, if the approved amount for a certain test is $500, a doctor who has not accepted assignment with Medicare may charge up to $575. Your loved is responsible for the extra $75.

That might not sound like a big difference, but it can add up quickly, especially since your loved one is responsible for 20 percent of the approved charges plus any required deductible and coinsurance.

How does billing work?

Instead of a bill, Medicare recipients get a Medicare Summary Notice in the mail every three months. This statement lists all the services received, approved amounts, and any balance owed. Be sure to review these statements carefully. If you find errors or want to appeal a claim, follow the directions on the notice.

Next Step: Offered by private insurance companies, a wide range of Medigap plans fill common gaps in Original Medicare coverage. Learn More

Find a Government Agency

  • Select a state to view agencies that may assist with caregiving and eldercare issues.