How does Original Medicare work?

Original Medicare is health insurance that is supported and managed by the federal government. It is one you your health coverage choices as a part of Medicare. With Original Medicare, you are typically required to pay a part of the cost for every service that Original Medicare covers.

 

FAQ’s

  • Can I acquire my health care from any health care provider, hospital, or Doctor? The majority of the time, yes. As long as the provider, hospital, Doctor, or any other health facility is currently enrolled in Medicare as well as accepting Medicare patients. Go to Medicare.gov to find and compare health care providers and other facilities in your area.
  • Am I required to choose a primary care doctor? No.
  • Do I need a referral in order to see a specialist? Usually, no; however, the specialist needs to be enrolled in Medicare in order to have it covered.
  • Are prescription drugs covered? No, most prescription drugs are not covered. If you would like to add drug coverage, join a Medicare Prescription Drug Plan.
  • What else should I know about Original Medicare?
    • Generally, you will pay a monthly premium for Part B.
    • Usually, you will pay a set amount for your deductible before Medicare covers its portion. Both you and Medicare pay your share for covered services and supplies. (There’s no yearly limit for what you pay yourself).
    • Normally, the law will require different providers as well as suppliers to file your claims for the supplies and services that are covered for you, so you generally will not need to file Medicare claims.

 

What do I pay?

Most do not have a premium for Part A and there is typically a premium for Part B.

Click below for the costs of A & B.

 

 

How do I know what Medicare paid?

If you have Original Medicare, then you will receive a “Medicare Summary Notice” (also known as an MSN) in the mail every three months that lists all of the services that are billed to Medicare. The MSN is not a bill, it shows what Medicare has paid and what you may owe the provider. Look through it thoroughly, and do the following things:

  1. Look to see if it covers anything Medicare did not, if you have other insurance.
  2. Hold on to all of your receipts and bills. Then, compare them to your MSN in order to make sure you received all of the services, supplies, or equipment listed.
  3. Compare your notice with any bills paid before you got your MSN, to make sure you paid the right amount for all services.
  4. You can file an appeal with any decision that has been made

Note: If you need to change your address on the notice, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you get Railroad Retirement Board (RRB) benefits, call the RRB. TTY users should call 1-312-751-4701.

 

Check your claims on MyMedicare.gov

If you wish to file an appeal or view your Medicare claims, you do not need to wait for your MSNs to come in through the mail. Go to MyMedicare.gov to look at your Medicare claims or view electronic copies of your MSNs. Claims will usually be available for viewing writhing 24 hours. If you wish, you can download your claims by using Medicare’s Blue Button.

 

Get Your Medicare Summary Notices electronically every month

You can receive your Medicare Summary Notices electronically every month. These are called eMSNs. To sign up, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you choose to sign up for eMSNs, we will send you an email every month when they are available in your MyMedciare.gov account. They contain the same information as paper MSNs. If you sign up for eMSNs, you will not relieve paper copies of your MSNs in the mail.