Below is the summary of benefits and your costs if you are enrolled in original medicare. Original medicare is part A and part B.
Notice that in most cases original medicare will pay 80% of the cost of medical services and you are responsible for 20% of the cost. Depending on the type of treatment needed this could become expensive. That is the reason so many people choose a medicare supplement or medicare advantage plan to help cover some or all of the portion of cost you are responsible for.
One other note on original medicare, and this is very important. You will notice that there is not an out of pocket maximum. That means that there is no limit to your financial obligation. This is another reason to consider a medicare supplement or advantage plan as these do come with out of pocket limits typically no more than $6800/year.
The information below is directly from the www.medicare.gov website and outlines your portion of the cost of the following medical services.
Benefits
Notice that in most cases original medicare will pay 80% of the cost of medical services and you are responsible for 20% of the cost. Depending on the type of treatment needed this could become expensive. That is the reason so many people choose a medicare supplement or medicare advantage plan to help cover some or all of the portion of cost you are responsible for.
One other note on original medicare, and this is very important. You will notice that there is not an out of pocket maximum. That means that there is no limit to your financial obligation. This is another reason to consider a medicare supplement or advantage plan as these do come with out of pocket limits typically no more than $6800/year.
The information below is directly from the www.medicare.gov website and outlines your portion of the cost of the following medical services.
Original Medicare
Monthly Plan Premium
Medicare Part A & B premium if not otherwise paid for
under Medicaid or by another third party.
Medical Deductible
Part B Deductible: $183
Maximum Out-of-Pocket
Responsibility (does not include
prescription drugs)
There is no limit to how much you will pay for covered
services.
Benefits
Original Medicare
Inpatient Hospital Coverage
In 2017 the amounts for each benefit period are:
-
$1,316 deductible for days 1 through 60
-
$329 co-pay per day for days 61 through 90
-
$658 co-pay each day for days 91 to 150 (lifetime
reserve days)
Covers 90 days for an inpatient hospital stay.
Doctor Visits
Primary
20% of the cost per visit
Specialists
20% of the cost per visit
Preventive Care
$0 co-pay
Emergency Care
20% of the cost
If you are admitted to the hospital within 3 days, you do not have to pay your share of the cost for certain services.
If you are treated in a hospital emergency room and then admitted as a hospital inpatient during the same visit, you do not need to pay cost sharing on the hospital bill for the ER visit. But you are responsible for cost sharing on the physician services during both the ER and the inpatient stay. (And also responsible for the inpatient deductible.)
If you are admitted to the hospital within 3 days, you do not have to pay your share of the cost for certain services.
If you are treated in a hospital emergency room and then admitted as a hospital inpatient during the same visit, you do not need to pay cost sharing on the hospital bill for the ER visit. But you are responsible for cost sharing on the physician services during both the ER and the inpatient stay. (And also responsible for the inpatient deductible.)
Urgently Needed Services
20% of the cost per visit
Original Medicare
Diagnostic
Tests, Lab
and Radiology
Services, and
X-Rays
(Costs for these services may
be di erent if received in an outpatient surgery setting)
(Costs for these services may
be di erent if received in an outpatient surgery setting)
Diagnostic
radiology services
(e.g. MRI)
20% of the cost
Lab services
$0 co-pay
Diagnostic tests
and procedures
20% of the cost
Therapeutic
Radiology
20% of the cost
Outpatient x-rays
20% of the cost
Hearing Services
Exam to diagnose
and treat hearing
and balance
issues
20% of the cost
Dental Services
Limited dental services (this does not include services
in connection with care, treatment, filling, removal, or
replacement of teeth): 20% of the cost
Vision Care
Exam to diagnose
and treat diseases
and conditions of
the eye
20% of the cost
Eyewear after
cataract surgery
20% of the cost
Mental Health
Care
Inpatient visit
In 2016 the amounts for each benefit period are:
-
$1,316 deductible for days 1 through 60
-
$329 co-pay per day for days 61 through 90
-
$658 co-pay each day for days 91 to 150 (lifetime
reserve days)
Covers 90 days for an inpatient hospital stay.
Outpatient group
therapy visit
20% of the cost
Outpatient
individual therapy
visit
20% of the cost
Original Medicare
Skilled Nursing Facility (SNF) (Stay
must meet Medicare coverage criteria)
In 2016 the amounts for each bene t period are:
-
You pay nothing for days 1 through 20
-
$161 co-pay per day for days 21 through 100
Covers up to 100 days in a SNF as long as you previously stayed in a hospital for 3 days.
Rehabilitation
Services
Occupational
therapy visit
20% of the cost
Physical therapy
and speech and
language therapy
visit
20% of the cost
Ambulance
20% of the cost
Routine Transportation
Not Covered
Foot Care
(podiatry
services)
Foot exams and
treatment if you
have diabetes-
related nerve
damage and/
or meet certain
conditions
20% of the cost
Medical
Equipment/
Supplies
Durable Medical
Equipment (e.g.,
wheelchairs,
oxygen)
20% of the cost
Prosthetics (e.g.,
braces, arti cial
limbs)
20% of the cost
Wellness Programs
Not Covered
Medicare Part B
Drugs
Most Part B drugs
20% of the cost
Outpatient
Surgery
Ambulatory
surgical center
20% of the cost
Outpatient
hospital
20% of the cost
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