Generally, the different parts of Medicare help cover specific services. Most beneficiaries choose to receive their Part A and Part B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called traditional Medicare or fee-for-service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that accepts Medicare (and most do) anywhere in the country.
In Original Medicare:
- You go straight to the doctor or hospital when you need care. You do not need to get permission/prior authorization from Medicare or your PCP.
- You are responsible for paying a monthly premium for Part B. Some also pay a premium for Part A.
- You generally pay coinsurance for each service you receive.
- There are limits on the amounts doctors and hospitals can charge for your care.
- If you want prescription drug coverage under Original Medicare, in most cases you will need to actively choose and enroll in a separate Medicare private drug plan (PDP).
Note: There are a number of government programs that can help lower your health care and prescription drug costs if you meet the eligibility requirements.
Unless you choose otherwise, you will have Original Medicare. Instead of Original Medicare, you can choose to get your Medicare benefits from a Medicare Advantage Plan, also called Part C or a Medicare private health plan. Remember, you still have Medicare if you join a Medicare Advantage Plan. This means that you still have to pay your monthly Part B premium (and your Part A premium, if you have one). Each Medicare Advantage plan must provide all of the Part A and Part B services covered by Original Medicare, but they may do so with different rules, costs, and restrictions that may affect how and when you get care.
It’s important to understand your Medicare coverage options and choose your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you get care. For example, in Original Medicare, you are covered to go to almost every doctor and hospital in the country. On the other hand, Medicare Advantage plans generally have network restrictions, which means you’ll likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage plans may also provide additional benefits that Original Medicare doesn’t cover, such as routine dental or vision care.
© 2022 Medicare Rights Center. Used with permission.
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