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Original Medicare Insurance

original medicareEligibility for Medicare, a federal health insurance program, begins once a person reaches the age of 65 or upon reaching 24 months on disability (age is not a factor in this case) for a qualifying-ailment. There are four parts to Original Medicare: A, B, C and D. Part A entails hospital coverage. Part B involves coverage for doctors. Part C is also known as Medicare Advantage or “Managed Care” (I.e. HMO, PPO, PFF and SNP). Part D involves prescription drug coverage (aka Prescription Drug Plans [PDP]). Some of the parts work in tandem but others do not. It’s important to make sure you know which ones do and which ones don’t.

Original Medicare Part A

Part A (hospital coverage) is usually offered to no added cost for people who qualify by having a minimum of 40 calendar quarters (or 10 years) of employment that involved paying Social Security taxes within the USA. Those qualifying for Railroad Retirement benefits are also eligible. Moreover, those who were federal employees after December 31, 1982 or a state or local government employee after March 31, 1986 will qualify for Part for free. The cost for Medicare Part A would normally run for $400 / month.  Part A (hospital) covers most hospital-related medically necessarily hospitals, skilled nursing facilities, hospice care and home health. Medicare Part A does not provide complete coverage and features a re-occurring deductible and additional out-of-pocket costs.

Original Medicare Part B

Medicare Part B is optional coverage for doctors and outpatient services requiring a monthly-paid premium based on the previous 2 years of annual income (see income chart). Medicare Part B provides coverage for most medically-necessary doctors’ services, hospital outpatient services, durable medical equipment, preventative care, lab tests, x-rays, mental health care and some ambulance expenses. Like Medicare Part A, Part B does not provide complete coverage, and there is a deductible, along with additional out-of-pocket expenses.  

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medicare part a & bOriginal Medicare Part C

Medicare Part C (or Medicare Advantage) lets private health insurance companies to offer Medicare benefits. Such private health plans are also referred to as HMOs, PPOs, PFFs and SNP. One can opt to get their Medicare coverage through Medicare Advantage plans, but it’s not possible to have Medicare Advantage and Original Medicare. Medicare Advantage plans are also required to provide the same benefits as Parts A and B but may also feature different costs, rules and coverage restrictions. One can also choose to get Part D along with Part C. When it comes to choosing Medicare Advantage plans, there are many options, identified by an approved area Network. You can pay monthly premiums for this coverage along with the Part B premium. Enrollment separate from one’s Open Enrollment is generally during October 15 through December 7 every year (or Annual Enrolment Period [AEP]).

Original Medicare Part D

Medicare Part D (or Medicare Prescription Drug Plans [PDP]) provides Rx drugs coverage. Part D is only available through private insurance companies with legal agreements with the US government and cannot be provided directly by the government. Should you decide that you want Part D, you must first choose coverage that is compatible with your Medicare health benefits. Should you already have Original Medicare, then you must pick a standalone Part D plan. Enrollment separate from Open Enrollment is generally between October 15 and December 7 every year (or Annual Enrollment Period [AEP]). If a Part D plan isn’t obtained while you’re eligible, a 1-percent penalty will be issued each month that you qualify. Should you enroll in Part D sometime in the future, then the penalty is paid separately to Medicare. It’s important to know about the 3 phases of coverage: initial coverage, donut-hole and catastrophic, especially for situations requiring high cost for Rx drugs.