You are here: Home Government ... Medicare: ... Summary
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Medicare: Original Fee-For-Service

Summary

Next »

1/8

Long established Medicare (Original Fee-for-Service Medicare) is the type of health insurance plan which lists what benefits it pays for in a schedule of benefits, allows the insured freedom of choice such as what doctors to see and what treatments to take, and Includes both deductibles and coinsurance. (In insurance talk, it is a traditional indemnity type health insurance policy.)

While Medicare is a benefit provided by the federal government, Medicare benefits are administered by private companies.

Medicare is divided into three parts:

  • Part A -- Hospital - The federal government pays Part A premiums for most Medicare beneficiaries. Part A includes hospice (end-of-life) care.
  • Part B -- Medical - Part B is considered voluntary in that each beneficiary pays for it. The cost for Part B coverage depends on your income. (To learn more, see: Original Fee-For-Service Medicare: Premiums).
  • Part D - Drugs

There are also Medicare Advantage plans, which cover at least the benefits provided by Original fee-for-service Medicare, and possibly more benefits. The trade-off is that choice is limited. (For information about Medicare Advantage plans, click here.)

In the private insurance world, indemnity policies don't pay more than "Usual and Customary" charges in your area. Medicare refers to the limitation on what it pays as the "Medicare Approved Amount."

The benefits provided by Original Medicare are generally subject to:

  • An annual deductible which you have to pay before Medicare pays any benefits
  • Your paying part of the costs of each service rendered,  either as a dollar amount  or a percentage of the cost of the care.

As you will see below, there is assistance available to help pay the costs of Medicare coverage.

When to enroll in Medicare depends on your circumstances. If you are on Social Security Disability Insurance (SSDI) for 24 months, you will automatically be enrolled in Medicare. You can disenroll to move to Medicare Advantage or for any other reason.

When Medicare coverage is effective depends on whether you sign up when you are first eligible due to age, or during another enrollment period.  

Original Medicare Fee-for-Service requires your doctor or other health care provider to file a claim directly with Medicare. Financial experts advise keeping track of your medical bills to make sure all charges are reviewed and proper payment is made, especially if you have Medicare and another health insurance plan.

  • If you have continuing access to the internet, Medicare posts bills and their status on www.MyMedicare.gov offsite link.  However, mistakes can happen so it is a good idea to keep your own records. For a simple method of keeping track, click here.
  • If you don't have continuing access to the internet, or want to be smart consumer, you can set up your own, preferably easy-to-use, system.
  • If you'd prefer, ask a friend or family member to help keep track of your medical bills. You can also hire a claims professional. See Medicare Claims: Professional Assistance

There are tips to consider for maximizing the use of Medicare.

If you already have health insurance, do the math to determine whether to keep your private coverage and pay for Medicare. As a general matter, for someone with a serious or chronic health condition, financial advisors suggest taking both if you can afford it.

For more information, see:

NOTE:

  • It is advisable to take advantage of Medicare coverage of one free wellness visit to a doctor each year, as well as its long list of preventive services with no deductiblecoinsurance or copay. Just because you have a health condition, it doesn't mean that you won't get another one. 
  • Medicare covers care for depression. We mention this specifically because depression generally occurs at some point after diagnosis of a serious health condition. 

Please share how this information is useful to you. 0 Comments

 

Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.