2-52 Medicare@Work for Employees Turning 65 -Medicare Stew

Medicare Stew – Part 1: What is Original Medicare

Today I am starting a short series to help simplify Medicare for you and your employees. I am calling it Medicare Stew. Because I don’t want you to stew over how complicated Medicare is to navigate with your employees. I will boil it down and identify some of the common Medicare ingredients to help you easily digest it. That way, when questions come from employees, you’ll feel more confident to help!

Ready to dig in?

What is Original or Traditional Medicare?

Original Medicare is the meat of Medicare. The federal government created Medicare primarily as a health insurance program back in 1965 to help older Americans manage their healthcare expenses.

To qualify for Medicare you or your spouse must have worked in the U.S. for ten years and paid taxes. Your 65th birthday is when your Medicare can begin.

Original Medicare consists of two parts:

• Part A: is hospital insurance (inpatient)
  • Coverage is primarily for expenses if you end up in the hospital. But it can also cover some home healthcare, hospice care, and if you go to a skilled nursing home for a short period of time.
• Part B: is medical insurance (outpatient)
• This coverage allows you to see any doctor for medical visits, surgery costs, lab tests, and durable medical equipment like wheelchairs. You can see a specialist without needing a referral from your primary care doctor.

Original Medicare provides a reasonably comprehensive plan. But it doesn’t cover everything. The almost 80% coverage is generous, but it won’t cover all necessary medical expenses completely. There are premium costs for the coverage too.

Premium Costs:

• Part A: is considered premium-free for folks aged 65 who (or their spouse) worked and paid Medicare taxes for at least 10 years. If you don’t get premium-free Part A, you pay up to $499 each month.
• Part B: has a monthly premium (in 2022 it is $170.10). Excess charges may apply in some cases.

Coverage:

• Part A: You will be covered when a doctor formally admits you to a Medicare-approved facility.
• Part B: the shortlist covers a bunch of common healthcare needs; including diagnostic tests like screening for bone density, and vaccines for flu and pneumonia. Also, your emergency services are covered here.

What’s Not Covered:

Original Medicare covers a lot- but it doesn’t cover everything! Original Medicare will not cover dental care, dentures, or routine eye exams. No coverage for massage therapy, cosmetic surgery, hearing aids, long-term care, or a provider who has opted out of Medicare fee-for-service. Also, if you are a traveler you won’t have coverage outside of the US. 

Original Medicare insurance is the start of coverage for Americans who leave their group plan at aged 65. There are other options for supplementing federally funded healthcare which we will dig into in the weeks to come. 

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– Lora