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Information about the Original Medicare Plan

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 Information about the Original Medicare Plan
Information about the Original Medicare Plan

Information about the Original Medicare Plan

You can pick the Original Medicare plan as one of the health care plan but you would have to stay with this plan until you enroll into either Medicare Advantage or any other Health Plan. You should know that the Original Medicare plan is fee-for-service plan, with red, white and blued colored card that's governed by the federal government. You are to pay set monthly premium for your Part B plan (Medicare covers its share of expenses) and can see any physician, who accepts Medicare. However, you should know if your service provider is accepting new Medicare patients or not.

Medicare will provide your with extra information on your plan on monthly basis about services you have received and what's your bill etc. by mailing a notice. Occasionally, you would receive two such notices, only if you have used drugs that includes some cancer treatment drugs, covered in Part B plan. One notice will provide you with information on Drug Company and other will notify you on your physician's visit. This notice will also inform you whether you drug claim has been approved or not. You have the option to file appeal, if you don't agree with Medicare's statement.

Below are listed some factors that influence your out-of-pocket expenses:

  • Your expense will be higher if you are enrolled into both, Part A and Part B plans.
  • If you frequently see physician/hospital for medical treatment. The kind of treatment needed by you.
  • If you have some other health insurance benefits that are with Medicare. And whether your physician accepts Medicare patients or not.

Remember, if services used by you are not covered by Medicare, then you are liable to all the medical expenses or you can also get Medicare supplemental insurance plan.

Cost of Your Medicare Plans

You cannot escape from paying fraction of your bill for the treatment or services you have received even if you are covered under Medicare Part A or Part B plan. You will also have to pay co-payments and co-insurance for your hospital stays, office visits and for any other medical treatment/services you might need.

Remember, you are to pay the amount for co-insurance and co-payments for the services, not covered in your plan or aforementioned list.

Understand Your Original Medicare Plan Assignment

Assignment is an agreement/deal between patients and Medicare, physician and other providers with Medicare. If you get enrolled into Medicare plan, you agree that doctor can bill Medicare for payment after your treatment. Also, know that physicians and providers cannot charge more than deductible and co-insurance amounts covered under Medicare. Physicians are not allowed to over-charge you for their services even if you have any other insurance.

Chances of physician and providers over-charging your for their services (not covered under your Medicare) are slightly higher, if your assignment is not accepted. Remember, if you don't have an assignment even then there's a limit on how much physicians can charge you. It's called "limiting charge" and it's 15% over Medicare's sanctioned amount. However, this "limiting charges" rule applies on some services and don't apply on services that are not covered under this "limiting charge "list. If you ever see physician that's not approved by Medicare then you will have to pay 100% costs for his/her services. You will have to file a claim with Medicare and only then they will pay their share of charges. Remember, physicians not with Medicare are under no obligation to file claims for you.

These rules are same for prescription drugs purchased from a pharmacy as well. Pharmacies with Medicare are obligated to accept your prescription drug assignment even if you are covered under Medicare Part B. But if you buy prescription drugs from pharmacy that is not with Medicare then you will have to file claim with Medicare, so they will pay their share. Pharmacies and suppliers are responsible to file claim on your behalf and cannot charge you for the use of glucose test strips.

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Information about the Original Medicare Plan

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