Original Medicare is made up of Medicare Part A and Medicare Part B. It is also referred to as “traditional Medicare,” because these benefits are received directly from the government, and not a private insurance company.
Medicare Part A Explained
Medicare Part A is also referred to as the hospital, or inpatient coverage part of the Original Medicare Plan. Medicare Part A covers 4 different services:
- Inpatient hospital care
- Skilled nursing facility (SNF) care
- Home health care
- Hospice care
To receive coverage for inpatient hospital care, you must be admitted by a physician into the hospital. You’re eligible for up to 90 days of coverage as an inpatient during each benefit period. You also have 60 lifetime reserve days.
A benefit period measures the use of your inpatient or SNF care benefits. It ends once you have been out of the hospital or SNF care for 60 consecutive days. If you’ve reached your deductible, Original Medicare will cover your inpatient hospital stay 100% for days 1-60. Once you reach day 61, you’re required to pay a daily coinsurance up until you reach day 90 of your inpatient hospital stay. If you require more time, you may also use your lifetime reserve days, but you’re required to pay a daily coinsurance cost to use them as well.
To qualify for SNF care coverage, you must have first spent three consecutive days in a hospital as an inpatient within the last 30 days of being admitted into SNF care. You must also require skilled nursing and or/therapy services. If eligible, Medicare will cover your room, board, as well as a variety of services provided in a skilled nursing facility. You qualify for 100 days for each benefit period. If you’re eligible for home health care, then you qualify for 100 days of daily care or an unlimited number of days with intermittent care. You will qualify for hospice care if your healthcare provider deems you terminally ill.
Medicare Part B Explained
Medicare Part B is also referred to as the medical, or outpatient, coverage part of the Original Medicare Plan. Medicare Part B covers two areas: medically necessary services and preventative services. This includes areas such as DME, or durable medical equipment coverage. Durable medical equipment is equipment that is medically necessary, durable, and useful in the home. Once your physician confirms you are in need of DME, you may purchase it from any Medicare-approved supplier. Medicare Part B also covers home health and ambulance services, therapy, and mental health services. This is not a full list of the coverage that Medicare Part B provides, but it is a glimpse of what it does provide coverage for.
Why is Medigap relevant when learning about Original Medicare? Because it supplements or adds to the basic Medicare plan. Once you’re enrolled in Medicare Part A and Part B, aka Original Medicare, then you can purchase a Medigap plan, which will help fill in the coverage gaps and reduce your out-of-pocket costs when you receive medical care. Even though Original Medicare may cover a lot, it does not fully cover your health needs. Medigap, or Medicare Supplement Plans, partners with Original Medicare to better provide coverage for those enrolled in traditional Medicare.
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