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Information on the original Medicare plan

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Information on the original Medicare plan

Information on the original Medicare plan

This is one of the options you have when you are opting for cover under Medicare. You should visit this page if you want to find out about one of the oldest plans offered by the government for aged people. It includes a number of fixed costs for particular procedures. It also includes the original plan assignment of the Medicare.

The original Medicare plan can be one of your choices. You have to remain in this plan unless you enroll for the Medicare Advantage plan or any other Medicare health plans available. The original medical plan is a fee for service plan that is managed by the federal government. The original medicare red, white and blue card will be given to you. Before you decide on a physician, make sure they accept new patients of Medicare. The payment you have to make for Medicare part B will be a fixed amount. You will receive your share of the covered expenses from Medicare.

You will receive a Medicare summary of accounts every month once you choose a health care plan. This service will give you information on the services you have availed, the amount of bills you may expect and other additional information. If you have received two of these, it means that you have received coverage from Medicare Part B. This coverage may include certain anti cancer drugs also. This notice contains information on your visits to the doctor and information on the drug company. The second notice lets you know whether your drug will be covered. If you feel that you disagree with the statement, you may file an appeal.

The out of pocket expenses incurred by you has many determining factors. These are –(1) whether you have Medicare Part A Or Part B, (2) how frequently you require treatment by doctors and at the hospital (3) whether your doctor accepts patients under Medicare (4) whether you have other insurance compatible with Medicare or the type of treatment you need. If you go for services that are not covered by Medicare, you will have to make the payments yourself. You may also look for Medicare supplemental insurance policy.

Your costs for original Medicare

If you are a member of Medicare Part A or Part B, you have to pay a share of your total medical costs. As is normal with most health insurance, you have to pay coinsurance and copayments for services like office visits and hospital stays. Here is an estimate of costs applicable .There may be limitations in the new plans regarding occupational therapy and speech, language services. It is best to contact your local insurance department for updated details.

  • Deductible for Medicare Part B: the first $110 in a year has to be paid by you.
  • Between 1 to 60 days of hospital stay: you have to pay $912 for every benefit period.
  • Between 61 to 90 days of hospital stay: you have to pay $228 for every day.
  • Between 91 to 150 days of hospital stay: you have to pay $465 for every day.
  • Hospital stay beyond 150 days: you have to pay all the costs for each day.
  • Up to 20 days of skilled nursing facility stays: you don’t have to pay anything.
  • Stays at skilled nursing facilities between 21 and 100 days: you have to pay $ 114 for each day.
  • Stays at skilled nursing facilities beyond 100 days: you have to bear all the costs.
  • Outpatient therapy, preventive care and doctor visits as well as DME: you have to pay 20% of the costs.
  • Home health services: you don’t pay anything if it is approved by Medicare.
  • Mental health and outpatient services: you have to pay 50% of the costs.
  • In patient blood requirements for the first 3 pints: 100% of the costs are to be paid by you.
  • Outpatient blood requirements for the first three pints: you have to pay 100% of the costs.
  • Outpatient blood requirements beyond 3 pints: you have to pay 20% of the costs.

You will also have to pay copayments and co insurances for other services that are not listed above.

Plan assignment for the Original Medicare

Assignment refers to the agreement of the patient on the on hand with doctors and providers of Medicare on the other. If you have Medicare, you basically agree to let the doctor bill Medicare for services provided to you. The providers and doctor cannot charge you more than the coinsurance amount and deductibles you pay.

If the assignment is rejected, the doctors may charge you more than Medicare will be willing to pay. In fact, the amount the doctors may charge is limited even if you do make the assignment. This is known as the’ limiting charge’ and is usually fixed at 15% over the maximum approved by Medicare. The limiting charge does not cover all costs. Only the costs mentioned in the list are covered under the rule. When you go to a physician who is not a part of Medicare, you may have to pay the entire charge at the time the service is being carried out. You will then file a claim for the costs incurred and Medicare will pay you its portion of the costs. Doctors who are not assigned with Medicare may not file the claims on your behalf, i.e. they are not legally bound to.

When you are thinking of filing your prescription from a pharmacist, the same rule applies. If you get prescriptions covered under Medicare Part B and the pharmacy is a member of the Medicare program, it has to accept assignment. If the pharmacy is not enrolled in Medicare, you will have to file a claim yourself if you want them to pay. If you are using glucose test strips, the pharmacy cannot charge you directly. Pharmacies and suppliers have to submit a claim for you.


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