insurance

Original Medicare

The traditional fee-for-service health insurance program run directly by the federal government, consisting of Part A (hospital insurance) and Part B (medical insurance). It allows you to see any doctor or hospital that accepts Medicare without network restrictions.

Example

“Robert chose to stay with Original Medicare rather than switch to a Medicare Advantage plan because he wanted the freedom to see any specialist without needing referrals.”

Memory Tip

Remember 'ORIGINAL = OPTIONS' - Original Medicare gives you the most options for doctors and hospitals without network restrictions.

Why It Matters

Original Medicare provides the broadest access to healthcare providers nationwide and doesn't require referrals for specialists, making it valuable for people who travel frequently or have complex medical needs. Understanding the difference helps you choose the best Medicare option for your situation.

Common Misconception

Many people think Original Medicare covers all their healthcare costs, but it has significant gaps including no prescription drug coverage (requiring Part D) and no annual out-of-pocket maximum. Some also believe it's inferior to Medicare Advantage, not realizing it often provides more flexibility and broader provider access.

In Practice

Eleanor, 68, has Original Medicare with Part A and Part B. She pays the standard Part B premium of $164.90 monthly. When she needs heart surgery, she can choose any surgeon in the country who accepts Medicare. Her costs are 20% of the Medicare-approved amount after meeting her $226 annual Part B deductible. For a $15,000 surgery, she pays the deductible plus 20% coinsurance ($2,955), totaling $3,181 out of pocket. To limit these costs, she also purchases a Medigap policy for $180 monthly that covers most of her coinsurance and deductibles.

Etymology

Named 'original' to distinguish it from newer Medicare Advantage plans (Part C) that were introduced later, with 'Medicare' combining 'medical' and 'care,' established by Congress in 1965.

Common Misspellings

origional medicareoriginal medicaidoriginal medicareorignal medicare

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Other insurance terms you should know

deductibleThe amount you pay out-of-pocket before your insurance begin…insurance premiumThe amount paid periodically to an insurance company in exch…deductibleThe amount a policyholder must pay out of pocket before insu…copayA fixed amount paid by an insured person at the time of a me…coinsuranceA cost-sharing arrangement where the insured pays a percenta…out-of-pocket maximumThe most an insured person will pay for covered healthcare s…

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