Original Medicare
Original Medicare, or Medicare Part A and Medicare Part B, is designed to cover the basics of your health care – things like hospitals, outpatient doctor visits, tests and preventive care.
Costs Associated with Original Medicare
With Original Medicare, you pay a set amount for your health care, called a deductible, before Medicare pays its share. Then, Medicare pays its share and you pay a percentage of the cost of the service, called coinsurance. There is no limit on what you can pay out of pocket, so if you have a lot of healthcare bills, your personal costs can add up.
You also have to pay a monthly premium for your Part B (Medical Insurance) costs. This amount is automatically deducted from your Social Security benefit payment.
It is important to remember that if you choose to purchase either a Medicare Supplement (Medigap) plan or to enroll in a Medicare Advantage plan, you still pay your Part B premium.
Some plans charge an additional premium for their Medicare Advantage plan, meaning that you pay both your Part B premium and your private insurance plan’s premium each month. With a Memorial Hermann Advantage HMO plan, monthly plan premiums start at $0, but you must continue to pay your required Part B premium every month.
Part A (Hospital Insurance) primarily covers inpatient costs. In general, Part A covers:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn't the only care you need)
- Hospice care
- Home health care
Part B (Medical Insurance) mainly covers two types of services:
Medically necessary services: Services or supplies used to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Here are examples of what Medicare Part B covers:
- Doctor visits
- Clinical research
- Ambulance services
- Durable medical equipment
- Mental health care
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
What Original Medicare Doesn't Cover
You should be aware that Original Medicare may not cover all of your health care needs. Here are examples of a few benefits that are not covered by Original Medicare but may be covered by private health insurance:
- Long-term care (also called custodial care)
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care
What if Original Medicare Isn't Enough?
If you choose Original Medicare, you may realize that some of the health care services you need are not covered, meaning that you have to either purchase a supplemental plan or pay for those services 100 percent out-of-pocket. You may also find that the deductible and coinsurance you have to pay for necessary services is more than you can afford.
To help lower these costs and pay for the health care services that Original Medicare does not cover, many people choose to either enroll in a Medicare Advantage Plan (also known as Medicare Part C) or purchase a Medicare Supplement (Medigap) plan.
Memorial Hermann Advantage HMO offers Medicare Advantage plans that provide you with all of your Part A and Part B coverage, plus you'll get additional benefits like:
- $0 copay for PCP visits
- Maximums on out-of-pocket costs
- Prescription drug (Part D) coverage
- Dental, vision and hearing benefits
- Access to telehealth service
- Fitness benefits and more
You will also have access to coordinated care from affiliated physicians, specialists, facilities and healthcare services available through the Memorial Hermann Advantage HMO plan network.
You can learn more about the added benefits you get by talking to one of our licensed Medicare agents at (866) 350-2715 (TTY 711).
View additional benefits offered in Memorial Hermann's Medicare Advantage HMO plan.