Original Medicare

Original Medicare is one of your health coverage choices as a Medicare recipient. You will have to decide if Original Medicare is the right choice for you or not.  If you decide that Original Medicare is what best fits your needs, then you don’t need to anything.  Everyone who becomes eligible for Medicare begins with Original Medicare.  Your other option is to enroll in a Medicare Advantage Plan, which we will discuss later. Original Medicare is run by the federal government and regulated by the Center for Medicare Services (CMS).  Under Original Medicare, you will generally have to pay a portion of the cost of each service you receive, except for some preventive services.

 

Choosing a primary care physician is not required under Original Medicare.  Original Medicare works like a PPO but it is not a PPO.  Like a PPO, you can go see any doctor, hospital or other health care provider that accepts to provide service to Medicare patients; no referral is needed.  However, unlike a PPO plan that has a limited network, Medicare contracts with doctors, hospitals, and other health care provider throughout the nation.  This is a tremendous benefit that you can utilize across the country.  So, if you live in CA and travel to New York for Christmas, you will be able to go see a doctor, specialist, hospital or other health care provider should you need to.

 

Like most plans, Original Medicare generally has a deductible.  A deductible is the amount that you are required to pay before Medicare begins to pay. Once you pay your deductible, Medicare will begin paying its share and you will pay your share, which will be your co-payment and coinsurance.

 

Regardless of whether you elect to stay with Original Medicare or a Medicare Advantage Plan, you usually must pay a monthly premium for Part B. See our page on Medicare Basics to learn about the different Medicare Parts.  You do not have to file claims to make sure your providers get paid, filing Medicare claims is done by your providers (doctors, hospitals, skilled nursing facilities etc.).

 

If you elected to stay with Original Medicare, every three months, Medicare will mail you a Medicare Summary Notice (MSN). The MSN lists all the services billed to Medicare. It also shows what Medicare paid your providers, and what you may still owe. One important fact to know is that the MSN is not a bill. It is for your review to be sure that you received the services, supplies, and/or equipment listed. If you ever notice any discrepancies between what Medicare was billed for and what you actually received, contact your provider and ask for an itemized list of services.  You may also contact Medicare at 1-800-633-4227.