Good Morning Ms. Toni:
I am turning 65 in Dec and retiring because of my health. I had a triple bi-pass September 2013 and 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? Is that a certain insurance plan? I do not want to enroll in the wrong plan and totally mess up my Medicare. Thank You, Samuel, a Katy Rancher reader.
Hello Samuel:
I will make this as simple as I can. I have consulted with confused Texans who have a PHD in higher education and understanding Medicare just frustrates them.
So let’s examine just what “Original or Traditional Medicare” is?
Most healthcare professionals and their office staff call Medicare, “Traditional” Medicare, but Medicare refers to the government health plan for those 65 or older, under 65 with certain disabilities or those with end stage renal disease (kidney dialysis) as “Original” Medicare”. You will not find “Traditional” Medicare anywhere on the medicare.gov website or in the Medicare & You handbook, but the two are the same.
Original or Traditional Medicare consists of Parts A and B only, and not the rest of the alphabet soup, Parts C or D.
Original/Traditional Medicare is also known as your Medicare card or as many refers to the card as the “red, white and blue card”. There is not a network with “Original/Traditional” Medicare. If your doctor or healthcare provider accepts Original Medicare or Medicare assignment, then they will accept Traditional Medicare because they are the same thing.
Original/Traditional Medicare… Parts A and B are explained below:
MEDICARE PART A (In-patient Hospital Insurance) pays for your medical care with an in-patient hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care. The Part A deductible for 2014 is $1,216.00 and can be used 6 times or 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 $1,216.00.
Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $152.00 co pay per day. After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost
MEDICARE PART B (Medical Insurance) helps cover for medically necessary services such as doctors’ services, office visits including doctor charges for surgery for an in-patient hospital stay, outpatient hospital care/services, tests, durable medical equipment and other medical services. Part B has a monthly premium of $104.90 for 2014. **Note: Part B and Part D premiums are now based on income…not everyone pays the same amount!!
Part B has a yearly deductible of $147.00. Once the $147.00 deductible has been met; Medicare pays 80% of the Medicare approved amount and you or whoever is on Medicare, will pay 20% of the Medicare approved amount.
Original/Traditional Medicare has some gaps and to fill the gaps is with a Medicare supplement that works directly with Original/Traditional Medicare, but the Medicare supplement has a premium.
Confused about Medicare and Social Security workshop –Tuesday August 5th at 2:00-4:00 pm. Join Toni King at the Toni Says Houston office at 10998 S. Wilcrest Dr, Suite 120, in the SW Houston/Stafford area. RSVP 832/800-4674. Reservations are required because seating is limited to 20.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide explaining Medicare is on sale at www.tonisays.com. Email questions to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
