What is Original Medicare?

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Original Medicare is the traditional fee-for-service program offered directly through the federal government.

Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor that takes Medicare (and most do) anywhere in the country. Original Medicare is sometimes called traditional Medicare.

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 must offer at least the same benefits as Original Medicare but can do so 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.

In Original Medicare:

  • You go directly to the doctor or hospital when you think you need care. You do not need to get permission first.
  • You pay a coinsurance for each service you receive (fee-for-service).
  • There are limits on how much doctors and hospitals can charge you.
  • Original Medicare includes:
    • Part A (Inpatient coverage)
    • Part B (Outpatient coverage)

Part A is sometimes called hospital insurance and Part B is sometimes called medical insurance. If you want Medicare drug coverage (Part D) with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).

  • It is a good idea to have supplemental insurance or your out-of-pocket costs with Original Medicare can be very high. You may get supplemental insurance, for example, from an employer or a Medigap policy that works specifically with Original Medicare. Supplemental coverage allows you to keep the flexibility of Original Medicare.
  • If you have low income, you may qualify for Medicare Savings Programs (MSPs) that help pay for the out-of-pocket costs of Medicare.

Once you are enrolled in Original Medicare, you can choose to get your health coverage from a Medicare Advantage plan, which is a Medicare private health plan like an HMO or PPO instead. You will get your Medicare Part A and B coverage from the private plan, but with different rules, costs and restrictions.



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