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medicare part d
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medicare part d
medicare part d

How does Original Medicare work?


Federally administered Medicare, or “Original Medicare,” is the name for the program. All services usually come with some sort of price tag. The basic guidelines are as follows:

Can I get my health care from any doctor, other health care provider, or hospital?

This is the case the majority of the time. You have the freedom to see any Medicare-approved doctor, hospital, or another medical facility that is taking new patients.

Are prescriptions covered in Original Medicare?

Most prescription drugs are not covered by Original Medicare, however, there are several exceptions. To supplement Original Medicare, a Medicare Drug Plan is an option (Part D)

Do I need to choose a primary care doctor?

You do not need to select a primary care physician in Original Medicare.

Do I have to get a referral to see a specialist?

Generally speaking, the answer is not.

Should I get a supplemental policy?

You may have coverage via your workplace or union that supplements what Original Medicare provides. If you do not already have health insurance that covers all of your medical expenses, you may want to look into Medicare Supplement Insurance (Medigap) plans.

What else do I need to know about Original Medicare?

  • Before Medicare begins paying for your healthcare, you will often be responsible for a deductible. Then Medicare will pay its portion, and you will be responsible for paying your portion (coinsurance or copayment) for Medicare-approved medical care. The total amount you must pay each year is not capped.
  • Part B typically has a monthly premium.
  • Medicare claims are not typically required. For services and goods that qualify for reimbursement, providers and suppliers are legally obligated to submit claims. The medical community, nursing homes, and home healthcare companies are all examples of places that provide healthcare.

Factors that affect Original Medicare out-of-pocket costs

  • Whether or not you have Medicare, parts A and/or B. Many people have both.
  • Whether or not your doctor, another healthcare practitioner, or supplier agrees to take responsibility for your treatment.
  • What sort of medical attention you require, and how frequently, will vary.
  • Medicare does not pay for nonmedical care, whether it’s medical attention or medical supplies. If you do, the bills will be entirely on your shoulders unless you have some other form of insurance that will kick in.
  • What, if any, supplemental health insurance do you have that can be used in conjunction with Medicare?
  • Whether or whether you are enrolled in Medicare and/or Medicaid and receiving state assistance with those programs.
  • If you have Medigap coverage (Medicare Supplement Insurance).
  • Whether or not you and your medical service provider enter into a confidential agreement.

What is Part A (Hospital Insurance)?

Care received in a hospital, nursing home, hospice, and in some cases at home are all covered under Part A.

  • Approximately how much does it cost for Part A?
  • Where do I find Part A?
  • Just what does the first section (A) consist of, exactly?

What is Part B (Medical Insurance)?

Services rendered by doctors, outpatient care, medical supplies, and wellness checks are all covered under Part B.

  • What does it cost for Part B?
  • Where do you go to register for Part B?
  • What services does Part B provide?

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