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.
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
