Original Medicare Plan – Things It Won’t Cover

Medicare Part A and Part B are often referred to as Original Medicare plan which is managed by the federal government of the United States. It is sometimes called Traditional Medicare and provides coverage to Medicare eligible individuals which includes access to doctors, hospitals, or other health care providers who accepts Medicare.

However, Original Medicare plan doesn’t cover everything.

If you happen to be needing certain services that Medicare doesn’t cover, then
you’ll have to pay for them yourself unless you have Medicare Advantage plan or
other Medigap insurance that will cover it.

Here are some of the items and services that Original Medicare doesn’t
cover: 

• Long-term care (also called custodial care)
• Most dental care
• Eye examinations related to prescribing glasses
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care

Factors that affect Original Medicare out of pocket costs:

• Whether you have Part A and/or Part B. Most people have both.
• Whether your doctor, other health care provider, or supplier accepts assignment.
• The type of health care you need and how often you need it.
• Whether you choose to get services or supplies Medicare doesn’t cover. If you do, you pay all the costs unless you have other insurance that covers it.
• Whether you have other health insurance that works with Medicare.
• Whether you have Medicaid or get state help paying your Medicare costs.
• Whether you have a Medicare Supplement Insurance (Medigap policy).
• Whether you and your doctor or other health care provider sign a private contract.

Other things you need to know about Original Medicare Plan:

• You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of- pocket.
• You usually pay a monthly premium for Part B.
• You generally don’t need to file Medicare claims. The law requires providers and suppliers to file your claims for the covered services and supplies you get. Providers include doctors, hospitals, skilled nursing facilities, and home health agencies.

Do you need a supplemental policy?

You may already have employer or union coverage that may pay costs that Original Medicare does’t. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy thru your trusted local insurance consultants.

Since Original Medicare plan isn’t free and doesn’t cover everything you might need, more and more people choose and Medicare Advantage plan or Medicare Supplement Insurance Medigap.