Original or Traditional Medicare…What is the Difference?
Good Morning Ms. Toni:
I am turning 65 in Dec. and retiring because of my health. I recently had a triple bi-pass and last week I talked with the office manager at my cardiologist’s office about me getting on Medicare and what I should do?
She said for me to enroll in “Traditional Medicare.” I have no idea what “Traditional Medicare” is. I cannot find Traditional Medicare anywhere in the Medicare and You Handbook? Is that a certain insurance plan?
I do not want to enroll in the wrong plan and totally mess up my Medicare.
Thank You, Samuel, a confused reader.
I will make this as simple as I can. I have consulted with confused Americans who have a PHD in higher education and understanding Medicare frustrates them too.
Let’s examine just what “Original or Traditional Medicare” is?
Most healthcare professionals and their office staff call Medicare, “Traditional” Medicare, but Medicare refers to the government health plan for those 65 or older, under 65 with certain disabilities or those with end stage renal disease (kidney dialysis) as “Original” Medicare. You will not find “Traditional” Medicare anywhere on the medicare.gov website or in the Medicare and You Handbook, but the two are the same.
“Original” or “Traditional” Medicare consists of Parts A and B only! NOT the rest of the alphabet soup, Parts C or D.
Original/Traditional Medicare is also known as your Medicare card or as many refers to the card as the “red, white and blue card”. There is not a network with Original/Traditional Medicare. If your doctor or healthcare provider accepts Original Medicare or Medicare assignment, then they will accept Traditional Medicare because they are the same thing.
Original/Traditional Medicare Parts A and B are explained below:
MEDICARE PART A (In-patient Hospital Insurance) pays for your medical care with an in-patient hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100-day benefit, hospice, or if you receive home health care. The Part A deductible changes every year and can be used 6 times or 6 deductibles in a year. Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible.
Skilled nursing has a $0 co-pay for days 1-20, but from days 21-100, there is specific co pay per day which also changes every year. After day 100, you pay all the cost for each additional day. And YES, the skilled nursing facility will invoice you the additional cost.
MEDICARE PART B (Medical Insurance) helps cover for medically necessary services such as doctors’ services, office visits including doctor charges for surgery for an in-patient hospital stay, all outpatient hospital care/services, tests, durable medical equipment (wheel chairs walkers, oxygen, and other medical services. Part B has a monthly premium which also changes every year.
Part B has a yearly deductible that also changes every year. Once the calendar year deductible has been met; Medicare pays 80% of the Medicare approved amount and you or whoever is on Medicare, will pay 20% of the Medicare approved amount.
Original/Traditional Medicare have some gaps and you can fill the gaps with a Medicare Supplement/Medigap Plan that works directly with Original/Traditional Medicare, but the Medicare Supplement/Medigap has a premium.
*Note Part B and Part D premiums are now based on income, not everyone pays the same amount!!