Original Medicare basics

Original Medicare Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. consists of Part A Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. and Part B Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. . If you have Original Medicare Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). , the government pays directly for the health care services you receive. Additionally, enrolling in Original Medicare means:

• You will receive a red, white, and blue Medicare card to show to your providers
• Most doctors in the country take your insurance
• Medicare limits how much you can be charged if you visit participating and non-participating providers, but it does not limit how much you can be charged if you visit providers who opt out of Medicare
• You can see a Specialist Specialist A specialist is a doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems. without Prior Authorization Prior Authorization Prior authorization, also known as pre-authorization or pre-approval, is a restriction placed on coverage by Part D plans and Medicare Advantage Plans. If a service or drug requires prior authorization, you must first get approval from the plan for it to be covered. If you fail to get prior authorization before you get the service or drug, your plan generally will not cover it.
• You are responsible for Original Medicare Cost-sharing Cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. , which may include premiums, deductibles, and coinsurances
• You are eligible to enroll in a Medigap policy, which can help reduce your Out-of-Pocket Costs Out-of-Pocket Costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them.

If you sign up for Original Medicare and later decide you would like to try a Medicare Advantage Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs).  Plan—or vice versa—be aware that there are certain enrollment periods when you are allowed to make coverage changes.

Original Medicare does not include the Prescription Drug Prescription Drug A prescription drug is a drug that can be obtained only if you have a prescription from a provider. Prescription drugs cannot be bought over the counter. benefit ( Part D Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. ), which is only offered through private companies. You should consider signing up for a separate Part D plan to ensure that you have coverage for your prescription drug needs.