If you’re approaching retirement age and wondering about your healthcare options, this article is for you.
We’ll tell you all about the ins and outs of every Medicare plan at your disposal, including the additional coverage choices available. In doing so, we’ll also dig into the eligibility criteria, enrollment periods, and how to make the most of your coverage.
By the end of this read, you’ll be informed to make a decision that is right for both your health and budget.
So, stay tuned and get ready to take charge of your healthcare.
1. What is Original Medicare?
Original Medicare, also known as traditional Medicare, is a federal government health insurance program for individuals aged 65 and above.
This program has two basic coverage choices: Part A and Part B.
Part A covers hospital stays, hospice care, and some skilled nursing facility care.
Part B covers doctor’s visits, lab tests, diagnostics, and a range of other outpatient preventative services.
What Original Medicare doesn’t cover are routine and eye check-ups, much of the dental work, and the majority of prescription drugs, but this can be remedied by enrolling in some of the additional Medicare plans.
For instance, you could enroll in Part C or Part D, which are coverages managed by private insurance companies, to include prescription drugs in your plan.
Essentially, you can look at the Original Medicare as the foundation upon which other plans can be added for better coverage.
2. Is Original Medicare Available to Individuals Under 65?
While generally reserved for a population aged 65 and above, Original Medicare may also be available to individuals under 65 with certain disabilities or medical conditions.
This includes:
- End-stage renal disease (ESRD), also known as permanent kidney failure that requires dialysis or a transplant; or
- Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
These conditions must be verified by your healthcare provider.
3. How Does Original Medicare Work?
After signing up for Original Medicare and choosing your coverage plan(s), you can schedule an appointment with any healthcare provider enrolled in Medicare programs, including specialists with no referral.
Since the network of healthcare providers enrolled in Medicare programs is wide, this means you get to have specialized care whenever you need it, at a time and place that works best for you.
Now, when it comes to payments, here’s how that part works:
You’ll start by paying a deductible for your healthcare. After that, Medicare will chip in and cover its share. Finally, for any covered services and supplies, you’ll make a coinsurance or copayment.
Finally, you might also be wondering about out-of-pocket costs, which is completely understandable.
While there’s no yearly limit for these costs, there are options available to help manage them. These include Medigap or Medicare Advantage plans as supplemental insurance.
As you can see, Original Medicare offers plenty of flexibility and choice in your healthcare options, without any restrictions associated with referrals or limited networks.
In fact, in most cases you don’t even need to file a claim; your providers will do it for you.
Medicare. Why is this a benefit? No need for a specialist referral. Why and for whom is this a benefit?
4. Is It Possible to Change Your Original Medicare Plan?
Absolutely!
Here are the times to make changes to your Medicare coverage plans in 2024:
- From January 1 to March 31, 2024, you can switch the Medicare Advantage plan for a different one, including Original Medicare. During this same period, you can also sign up for the Part A and Part B plans.
- From October 15 to December 7, you can tweak your Medicare Advantage or Part D plan for some extra benefits or revert to Original Medicare.
If your health needs have changed and you now require a different type of care, or if you’re simply looking for a more budget-friendly option, consider giving your Medicare plan a check-up so that it keeps meeting your needs.
5. Should You Upgrade Your Original Medicare Plan to an Advantage Plan?
The answer to this question will vary greatly depending on your health needs, budget, and preferences.
For instance, many individuals have noted that switching to a better plan doesn’t necessarily lead to easier access to care, as prior authorization requirements can still pose challenges and result in delays in receiving necessary medical treatments.
In fact, sometimes paying for dental and vision services out-of-pocket is less of a hassle than dealing with the frequent denials of preauthorization by Advantage insurers.
Moreover, while Advantage plans are generally beneficial for anyone who needs dental, vision, and hearing coverage, some of those plans may have limitations such as a maximum annual coverage amount that may not fully cover all anticipated expenses.
Lastly, many suggest looking into Part D first because of its prescription drug coverage. And, if you qualify for Medicaid, sticking with original Medicare is recommended, as Medicaid can cover any extra costs.
6. What is the Medicaid Program and Who Is It For?
Since we’ve mentioned it in the previous section, here’s some more information about Medicaid:
Medicaid program services low-income families by covering their medical costs fully or in part. Under certain circumstances, some individuals are eligible for both Medicare and Medicaid, whereas Medicaid typically covers costs that Medicare doesn’t,
This includes certain prescription drugs, dental exams, and long-term care.
If you think you might qualify for Medicaid, and have high medical expenses, this program is worth exploring your options.
For more detailed information about Original Medicare and how it works, download our FREE Medicare Guide and review all of the available Medicare options and coverage plans.
Conclusion
While not without its limitations, Original Medicare is still an option that provides foundational healthcare coverage for millions of Americans.
If you value the freedom to choose your healthcare providers without the need for referrals, Original Medicare offers you this kind of flexibility and accessibility.
This can be particularly beneficial for individuals who require frequent medical care or have challenging health needs.
For those of you who require some extra coverage beyond what Original Medicare offers, there are still Medicare Advantage plans and supplemental Medigap policies available to you.
Ultimately, the best choice depends on each individual’s circumstances. Either way, you should take a look at all available options and consider factors such as health status and budget before making a final decision.
Article Submitted By Community Writer
