Doctor’s Advice…Get Traditional Medicare…What’s That?

Good morning, Toni:   

Have been reading your column for over a year and now I need some Medicare help. I am retiring and turning 65 in October. I had a triple bi-pass in January of this year. Last week I talked with the office manager at my cardiologist’s office about me getting on Medicare and what I should do. She said for me to enroll in “Traditional Medicare.”  I have no idea what “Traditional Medicare” is?

Could you please explain this and make it easy to understand? I do not want to enroll in the wrong plan and need guidance. Thank You, Samuel, from Kingwood area

Hello Samuel:

I will make this as simple as I can. I have consulted with confused Americans who have a Ph.D. in higher education and understand Medicare just frustrates them. It can make a grown man want to “cry”!

Let’s examine just what “Traditional Medicare” is and we will do this together.

Most healthcare professionals call Medicare, “Traditional” Medicare, but Medicare refers to it as “Original” Medicare. You will not find “Traditional” Medicare anywhere on the medicare.gov website or in the Medicare & You handbook.

Original or Traditional Medicare consists of only Medicare Parts A and B, and not the rest of the alphabet soup such as Parts C or D. Original/Traditional Medicare is also known as your Medicare card or as many on Medicare refer it as the “red, white and blue card.”

There is not a network with “Original/Traditional” Medicare, and this is very hard for those who have retired with employer group health insurance to understand, “NO Network”! If your hospital, doctor, or healthcare provider accepts Original Medicare or Medicare assignment, then they will accept Traditional Medicare because both are the same thing.

Original/Traditional Medicare… Parts A and B are explained below:

MEDICARE PART A (In-patient Hospital Insurance) is for an in-patient hospital stay. Part A’s deductible for 2022 is $1,556 and has 6 deductibles in a year. Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1556. Skilled nursing has a $0 co-pay for days 1-20, but from days 21-100, there is $194.50 co-pay per day. After day 100 in a skilled nursing facility, you pay the cost. Medicare Part A also includes hospice and home healthcare with a $0 co-pay.

MEDICARE PART B (Medical Insurance) has a premium of $170.10 which is based on income. One must enroll in Part B the correct way especially after turning 65 and “still working”. Part B covers “medically necessary” services such as doctor charges for office visits, surgery for inpatient or outpatient hospital stays, outpatient hospital care/services, tests, durable medical equipment, and other medical services.

Part B has a yearly one-time deductible of $233 for 2022. Medicare pays 80% of the Medicare-approved amount and you or will pay 20% of the Medicare-approved amount. A Medical provider may charge $1,000 for a service, but Medicare may approve $623. It is the $623 that the 20% is applied to.

More information regarding Original/Traditional Medicare is explained in the Medicare Survival Guide® Advanced edition available at www.tonisays.com.

A Medicare Supplement works only with Original/Traditional Medicare and does have a monthly premium based on which Medicare Supplement plan one selects. Call 832/519-8664 for Medicare help.

• Confused about Medicare Zoom webinar is Thursday, May 19th at 4:00 PM. Central Time Visit tonisays.com to sign up for the Toni Says online webinar event.

Toni King, author of the Medicare Survival Guide® Advanced edition is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com.