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Original Medicare
What Does Original Medicare Cover?
Part A and Part B
Medicare Parts A & B, or Original Medicare, is sometimes called “Traditional Medicare” or “fee for service” Medicare. With Original Medicare, you can go to any doctor, hospital, skilled nursing facility or outpatient treatment clinic that accepts Medicare assignment. Original Medicare is made up of two parts: Part A, which covers mostly inpatient care, and Part B, which covers mostly outpatient care.
Part A
Hospitalization
Part A is often called hospital insurance because it pays for your care while you are in the hospital. Part A also pays some of the costs if you stay in a skilled nursing facility or if you get healthcare at home. Finally, Part A covers hospice care for people who are terminally ill. Part A covers some of the costs for the following:
Inpatient Hospitalization
Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care.
Skilled nursing facility (SNF) care
Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.
Medicare-covered services include, but aren't limited to:
- Semi-private room (a room you share with other patients)
- Meals
- Skilled nursing care
- Physical and occupational therapy
- Speech-language pathology services
- Medical social services
- Medications
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
Nursing Home Care
Depending on what kind of coverage you have, Medicare may pay for your health care and prescription drugs while you're in a nursing home.
Original Medicare doesn't pay for most nursing home care. Most nursing home care helps with activities of daily living. Medicare covers very limited and medically necessary skilled care or home health care if you need skilled care for an illness or injury and you meet certain conditions.
Hospice
If you qualify for hospice care, you and your family will work with the hospice team to set up a plan of care that meets your needs.
Home Healthcare
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.
Part B
Medical Expenses
Many people who have Medicare don’t go to the hospital, but everyone sees adoctor or needs screenings and lab tests at some point. Part B pays for these doctors’ services,outpatient hospital care and home healthcare, which is not covered by Part A.
Unless you make another choice, you will have Original Medicare. You can also choose to get your Medicare benefits from a Medicare private health plan. Medicare private health plans, also called Medicare Advantage Plans or Medicare Part C, must offer at least the same benefits as Original Medicare. They can do this but with different rules, costs and restrictions. You may be automatically enrolled in a Medicare private health plan if your employer sponsors one when you become eligible for Medicare.
Medicare doesn't pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker Services include shopping, cleaning, and laundry when this is the only care you need
- Personal care given by home health aides, like bathing, dressing, and using the bathroom, when this is the only care you need.
It is necessary to understand to avoid late payment penalties when you need to enroll into Part's A, B, and D. If you are on group, it may be your best option to stay on group but be sure to contact us to determine whether the current healthcare plan is considered to be credible coverage. For example, Cobra, Veteran's Affair (VA), and some group (depending on size of company) may not be credible and would receive a 10% per year penalty that will not disappear at future enrollment. Contact us to avoid these late enrollment fees and "assure" yourself with your healthcare decisions. Even if you decide to stay on group company insurance, in many cases you may have better options available with Medicare. Call us at 480.369.6965 to have a complete summary of benefits comparison review between your group and Medicare options.