Medicare Explained

What is Medicare?

Original Medicare is the traditional federal health insurance program managed by the U.S. government. Original Medicare covers hospital and medical insurance. The benefits are standardized worldwide and allow you to see any doctor or hospital in the United States that accepts Medicare.

Medicare is a health insurance program that provides coverage for people who are 65 and older or who qualify due to certain conditions or disabilities. The Medicare insurance program provides various parts and options for healthcare coverage to qualified individuals.

What Does Original Medicare Cover?

Understanding Original Medicare coverage is the foundation of making smart healthcare decisions in retirement. Whether you live in Florida or anywhere else in the country, the structure of Original Medicare is the same. Keep reading for a full breakdown of how Medicare covers medical expenses.

Medicare Parts 

Medicare coverage is divided into subcategories called “Parts,” and each one is purchased separately. The Parts are A, B, C, and D. Each part has a different premium.

Medicare Part A

Medicare Part A primarily covers inpatient and hospital-related care. Most individuals do not pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.  The most common inpatient expenses Medicare covers are:

• Hospital Visits
• Overnight Admissions
• Patient Meals
• Hospice Care
• Skilled Nursing Facility care (short-term, after a qualifying hospital stay)

Medicare Part A is free for most beneficiaries, but you may be charged a monthly premium if you or your spouse didn’t work and pay Medicare payroll taxes for up to ten years. Medicare Part A also charges copays, deductibles, and coinsurance.

With Medicare Part A, costs and coverage are determined by a benefit period. A benefit period begins when a patient is admitted to a hospital or SNF. Once the patient has been out of the facility for 60 days, the benefit period stops. A new period begins after the previous 60-day period ends, and if the patient is admitted into the hospital again. A deductible is charged by Medicare Part A for each benefit period and provides coverage for most costs up to a 60-day hospital stay.

Medicare Part B

Medicare Part B covers outpatient and medically necessary services you would get outside of an emergency room, hospice center, or skilled nursing facility. Part B does require a monthly premium, and most services are subject to cost-sharing. Preventive services are a major benefit. Many screenings and vaccines are covered at no additional cost when provided by participating providers. Some of the expenses that Part B covers are:

• Doctor visits
• Specialist appointments
• Preventive services- Annual wellness visits, screenings
• Lab tests
• X-rays and imaging
• Outpatient surgeries
• Ambulance services
• Durable medical equipment (DME) – CPAP machines, insulin pumps, wheelchairs, etc.
• Some home health care

Medicare Part B provides coverage for most of the things you would get in a healthcare facility as an outpatient. It has an annual deductible and a monthly premium. Also, Medicare Part B continues to pay 80 percent of Medicare-approved costs, leaving you responsible for the remaining 20 percent. Please fill out the form below to get the latest rates.

What About Preventive Care?

Preventive services are one of the strengths of Original Medicare coverage. These benefits are designed to detect health issues early and promote long-term wellness. Some of the services covered are:

• Annual wellness visits
• Mammograms
• Colon cancer screenings
• Cardiovascular screenings
• Diabetes screenings
• Flu shots and certain vaccines

• Cancer screenings
• Lab tests
• Chemotherapy
• Wellness Visits
• Medicare Part B coverage

Medicare Part C – Medicare Advantage

Medicare Part C is a combination of Medicare Parts A and B, known as Medicare Advantage. Part C is sold through private insurance. It features inpatient (Part A), outpatient (Part B), and in most cases, prescription drug (Part D) coverage together.  These plans may include additional benefits. Understanding the difference between Original Medicare coverage and Medicare Advantage is essential when choosing coverage. Click here to learn more about Medicare Advantage.

Medicare Part D

Part D covers prescription medication costs, but only for select medications in specific categories outlined in the “formulary.” The formulary must cover at least two medications in each of the six medication categories. Part D medication categories are:

• Antidepressants
• Anticonvulsants
• Anticancer
• Immunosuppressants
• Medications for HIV/AIDS
• Antipsychotics

Who Should Consider Original Medicare?

Original Medicare may appeal to individuals who:

• Value nationwide provider access
• Travel frequently
• Want predictable coverage with a supplement
• Prefer flexibility without network restrictions

How Cost-Sharing Works with Original Medicare

Original Medicare may not cover your annual out-of-pocket medical spending. Supplemental coverage plans are available to help with these additional costs. Some of the medical cost-sharing you should expect may include:

• Deductibles
• Coinsurance (typically 20% for Part B services)
• Hospital deductibles under Part A

What Is Not Covered with Original Medicare?

Understanding what Original Medicare does not cover is just as important as knowing what it does. Original Medicare generally does not cover:

• Routine dental care
• Vision exams for glasses
• Hearing aids
• Long-term custodial care
• Most prescription drugs

What Is Medigap (Medicare Supplement Insurance)?

Medigap policies are private plans designed to help cover the “gaps” in Original Medicare. You still use Medicare nationwide, but the supplement helps reduce out-of-pocket costs. These plans may help pay for:

• Part B coinsurance
• Deductibles
• Certain excess charges

How Original Medicare Works Nationwide (Including Florida)

If you live in Florida, your Original Medicare coverage in Florida benefits are the same as in any other state. However, plan add-ons such as Part D or Medigap are selected based on your ZIP code. Once you are approved for Medicare, you can:

• See any provider nationwide who accepts Medicare.
• Travel without worrying about regional network restrictions.
• This nationwide access is one of the biggest advantages of Original Medicare.

Preparing to Enroll in Original Medicare

Understanding what Original Medicare covers allows you to build the right combination of coverage for your needs. If you are approaching 65, preparation is key. The key areas you should review before signing up for Medicare are:

• Review your Initial Enrollment Period
• Confirm whether enrollment is automatic
• Evaluate whether you need Part D
• Compare Medigap vs Medicare Advantage

Need Help? Orlando’s Top Medicare Broker is Here to Help!

Original Medicare provides broad hospital and medical coverage, but understanding its limits is essential for making informed decisions. Whether you choose to stay with Original Medicare and add supplemental coverage or explore Medicare Advantage options, knowing the foundation allows you to plan confidently.

If you need more information or help understanding Original Medicare coverage, or you have any other questions, then fill out the form below to contact our licensed and experienced Medicare Specialist at Medigap Supplement Headquarters today.