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Original Medicare


Original Medicare is one of the health coverage choices you have available as part of Medicare. You will have Original Medicare unless you elect to go with a Medicare Advantage Plan (such as an HMO or PPO).


Below are a few general rules about how Original Medicare works:

What am I going to pay with Original Medicare?


Your out-of-pocket expenses on Original Medicare depend on:


  • If you have Part A and/or Part B. Most individuals have both.
  • If your doctor, other healthcare provider, or supplier accepts “assignment.”
  • The type of care that you need and how often you’re going to need it.
  • If you choose to get services or supplies that Medicare doesn’t cover. If you do, you’ll pay all costs unless you have other insurance that covers it.
  • If you have other form of health insurance that works with Medicare.
  • If you have Medicaid or get help from your state when it comes to paying your Medicare costs.
  • If you have a Medicare Supplement Insurance (Medigap) policy.
  • If you and your doctor or any other healthcare provider sign a private contract


How will I know what Medicare paid?


  • If you have Original Medicare, you’ll be receiving a “Medicare Summary Notice” in the mail every 3 months. This list will show you all of the services that have been billed to Medicare. The Medicare Summary Notice shows what Medicare has paid and what you may owe your doctor/hospital/provider.


IMPORTANT: The Medicare Summary Notice isn’t a bill. Read it carefully and make sure of the following:


  • If you’re covered by a secondary insurance, check to see if it covers anything that Medicare didn’t pay for.
  • Save your receipts and bills. Take the time to compare them to your Medicare Summary Notice to be sure that you got all of the services, supplies, or equipment listed.
  • If you ended up paying a bill before you received your Medicare Summary Notice, compare that notice with your bill to make sure you paid the correct amount for services received.
  • If you do not agree with any decisions made by Medicare, you can file an appeal.


Can I add prescription drug coverage (Part D) to my Original Medicare?


With Original Medicare, if you do not have creditable prescription drug coverage (such as, from a current or former employer or union) and you would like Medicare prescription drug coverage, you must join a Medicare Prescription Drug Plan.


These plans are made available through private insurance companies that are under contract with Medicare. If at this moment you do not have creditable prescription drug coverage, you should consider joining a Medicare Prescription Drug Plan as soon as you’re eligible.


If you currently do not have creditable prescription drug coverage and do not join a Medicare Prescription Drug Plan when you’re first eligible, you might have to pay a late enrollment penalty if you decide to join later.


Do you have more questions about Original Medicare? Our Mentors can help you!



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