Traditional (Original) Medicare Explained

What is Original Medicare?

• It 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.
• Original Medicare covers 80% of medical expenses. Clients are responsible for the 20%.
• This includes Part A and Part B coverage if you enroll in both.
• There is also Medicare Part D (Drug coverage) and an optional supplemental insurance that picks up the 20% that original Medicare does not cover.
• Open Enrollment starts on October 15th to December 7th.

What does Part A cover?

• In general part A covers: Hospital Care, Skilled Nursing Facility Care, Nursing home care (as long as custodial care isn’t the only care you need), Hospice, and Home Health Services.
• Medicare as well covers services like lab test surgeries and doctor visits. Supplies such as wheelchairs and walkers are as well covered when medically necessary to treat a disease or condition.
• There is no Part A premium (monthly fee).

What does Part B covers?

• Medicare Part B covers 2 types of services:
  • Medically necessary services such as services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness or detect it at an early stage.
•  Part B as well covers things like: Clinical research, ambulance services, Durable medical equipment (DME), mental health (Inpatient, Outpatient, and Partial hospitalization), getting a second opinion before surgery, and limited outpatient prescription drugs.
• According to Medicare.gov Monthly Premium (fee) is based on your W2.
• There is approximately a $185 yearly deductible and the monthly premium (fee) is approximately $144.30 depending on your income.

Medicare Part D and Supplemental insurance (optional)

• Medicare Part D covers prescriptions. There are several plans available; you can choose one depending on the prescriptions you are currently taking. Monthly Premiums (fees) and deductibles vary depending on the plan you choose. Monthly premiums (fee) range from $15-$50. Yearly Deductibles may range from $300-$500.
• Supplemental insurance (Medigap). This type of supplemental insurance helps pay your out-of-pocket costs in Original Medicare. Depending on the type of supplemental insurance you choose there is a monthly Premium (fee). It may vary from $80-$250/month.

To learn about costs and plans please visit Medicare.gov to choose a plan to fit your needs.

Villa recommends Traditional Medicare for seniors age 75+.

Call Lisa Witt at 505-797-8735 to learn why.

Also always remember to consult with your doctor for proper diagnosis and treatment.

Reference: http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&script_id=1679 https://www.cms.gov/center/special-topic/

Thank you to Senior Allegiance Home Care for providing these Healthy Living Senior Tips for our Villa Assisted Living seniors in Corpus Christi, Texas.

For more Information, call Administator Karina Walker, RN BSN at Senior Allegiance at 713-975-1519 or www.SeniorAllegiance.com
or Executive Directors Patricia Torres at 361-991-3252 or Tonda Johnson 361-242-9446 or South@VillaAssistedLiving.com.

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Another great resource to check out is 5 Tips for Choosing an Assisted Living Community.