Original Medicare

Medicare Parts A and B are often called “Original Medicare.” It’s managed by the federal government and provides basic coverage for Medicare beneficiaries.

It is a fee-for-service plan, meaning that Medicare usually pays a fee for each service, up to a pre-determined amount, then the Medicare beneficiary pays for the remainder.

So it doesn’t pay for everything. For most professional services, the Medicare Beneficiary pays the deductible, then 20% of all costs. There is no “ceiling” or out-of-pocket maximum to how much he or she must pay.

That means if something catastrophic were to happen, and a beneficiary were have a catastrophic event and get charged $100,000 in professional fees, he or she would be responsible for $20,000 of those fees. Possibly more.

The table to the right shows the portions of the bills that Medicare doesn’t pay. These are often referred to as “The Medicare Gap.” The good news is there is an affordable way to cover this gap and leave you with excellent benefits with little to no out of pocket expenses for care.

The Medicare "Gap" - Medicare Deductibles, Copays & Coinsurance​

Part A (Hospitalization) Deductibles and Copays

Part A (Hospitalization) Deductibles and Copays
Inpatient Deductible – First 60 days$1,340 per benefit period
Inpatient copay days 61-90$335 per day
Inpatient copay days 91-150$670 per day
Skilled Nursing Facility copay days 1-20No coverage
Skilled Nursing Facility days 21-100$167.50 per day
Skilled Nursing Facility Days 100+No Coverage

Part B (General Medical) Deductibles and Coinsurance

Part B (General Medical) Deductibles and Coinsurance
Calendar Year Deductible$183 per Year
Coinsurance80% / 20%

Frequently Asked Questions about Original Medicare

Generally speaking, no. Original Medicare does not cover prescription drugs. There are some exceptions to the rule, such as a drug that is administered while in an inpatient hospital. You can get drug coverage by enrolling in a Prescription Drug Plan (“Part D”.)

Yes and no. You can go to any doctor or hospital that accepts Medicare patients. Most do, so you’re probably okay. But you should check before assuming anything.

No. With Original Medicare, you can self-refer to a specialist or supplier.

Most people don’t pay a premium for Part A, as long as they (or their spouse) has paid Medicare taxes while working.

For Medicare Part B, most people pay a standard premium. Others may pay an additional amount based on their income.

The standard Part B premium for 2018 is $134 per month.

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