Original Medicare is Medicare that is administered directly by the federal government. It is fee-for-service coverage, which means you can go to any doctor or hospital you choose, as long as they accept Medicare, and the government will pay for any services or required testing.
You have to pay is your coinsurance and deductible. Original Medicare is made up of Part A and Part B. Part A is your hospital coverage while Part B is your medical coverage that covers doctor’s visits and other outpatient services.
The standard monthly premium for Medicare Part B is $134. However, many people are charged less than this amount, depending on their social security benefits. Most people who pay the full premium do not receive social security benefits, are receiving Medicare for the first time, or have income above a certain threshold. Most people do not pay a premium for Medicare Part A (Hospital Services).
Medicare Part B Deductible and Co-Insurance
As doctor’s services are covered under Part B, you’ll have to meet your deductible before the government will pay for any services. The current Part B annual deductible is $183. Once your deductible has been met, you will be responsible for 20% of charges doctor’s visits and any other outpatient care services you receive. This 20% is called co-insurance.
The 20% co-insurance charge applies to doctors who participate in the Medicare program. However, there are some doctors, known as non-participating doctors, who only occasionally see Medicare patients. If you go to a non-participating doctor, you’ll have to pay an additional charge over your 20% co-insurance, which can be up to 15% (for a total of 35% of all services). However, some states limit the additional percentage that non-participating doctors can charge. For more information about these charges, contact your State’s Health Insurance Assistance Program.
Some doctors don’t work with Medicare at all, and in the event that you want to go to one of these doctors, you’ll have to sign a contract acknowledging that you are responsible for the full cost of treatment. This mostly happens with certain specialists, such as psychiatrists.
If the doctor deems it medically necessary, Medicare Part B will pay for your medical supplies, subject to your 20% co-insurance payment, as long as the equipment provider is approved by Medicare.
Ambulance and Transportation Services
Medicare Part B will also pay for ambulance services in an emergency. However, in non-emergency cases, the services must be medically necessary. In general, the patient must be unable to walk or sit in a wheelchair for coverage to apply.
Medicare Part B covers outpatient services, but they need to be authorized by your doctor as medically necessary. Services covered included physical therapy, occupational therapy, and speech therapy. Chiropractic services are even covered when approved by your doctor as being medically necessary. In addition, outpatient mental health services are also covered.
In-home nursing and physical therapy services are also covered under Medicare Part B.
As a general rule, Medicare Part B doesn’t cover prescription drugs, as Medicare’s prescription benefit is under Part D. However, certain anti-cancer drugs, which are not normally self-administered by the patient, are covered by Medicare Part B.
As a Medicare beneficiary, it’s important that you know your benefits and your rights. You can get more information at Medicare.gov. In addition, you can call Medicare’s national hotline at 1-800-MEDICARE.