What is Traditional Medicare?
Good Morning Ms. 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 April 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 totally mess up my Medicare.
~ Thank You, Samuel
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. It can make a grown man want to “cry”!
After last week’s Medicare workshop at the Examiner’s office, because doctor’s offices are advising their current patients to enroll in “Traditional Medicare”. Let’s examine just what is “Traditional Medicare” and we will do this together.
Most healthcare professionals call Medicare, “Traditional” Medicare, but Medicare refers to it “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 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. 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) comes at no cost. Most people are enrolled automatically in Part A when they reach 65. Part A is for an in-patient hospital stay. Part A deductible for 2015 is $1,260 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 $1260.00 Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $157.50 co pay per day. After day 100, you pay all of the cost for each additional day. Part A also includes hospice and home healthcare with a $0 co pay.
MEDICARE PART B
(Medical Insurance) has a premium of $104.90 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 $147.00 for 2015. Medicare pays 80% of the Medicare approved amount and you or will pay 20% of the Medicare approved amount. A Medical provider may charge $1,000.00 for a service, but Medicare may approve $623.00, it is the $623.00 that the 20% is applied to.
If you see a doctor who does not accept Medicare-approved amounts, you will pay more-possibly up to full cost for the doctor’s visit and care.
A Medicare supplement works directly with Original/Traditional Medicare, but has a premium.
Toni King, author of the Medicare Survival Guide®, is on sale at www.tonisays.com “Confused about Medicare Workshops” are taking a summer vacation and will return in August. Personal consultations are available by contacting Toni at www.tonisays.com/ask-toni or call 832/519-8664.
