Medicare beneficiaries have choices for receiving health care services. The Original Medicare Plan is the traditional fee-for-service Medicare plan that is available nationwide. A beneficiary can see any doctor or provider who accepts Medicare and is accepting new Medicare patients. Or a beneficiary can choose a Medicare Advantage Plan (Part C). Medicare Advantage Plans combine Part A and Part B and, in some cases, Part D prescription drug coverage. In limited instances, other Medicare Health Plans may be available. Visit Medicare's website to find out which Medicare choice options are available in a specific area.
A beneficiary must have both Medicare Part A and Part B to join a Medicare Advantage Plan, and the individual must live in the plan's service area. Under a Medicare Advantage Plan, a beneficiary may pay lower copayments and receive extra benefits.
Original Medicare Plan
Under the Original Medicare Plan, patients visit the hospital, doctor, or health care provider of their choice who accepts Medicare patients. Medicare pays a set percentage of the expenses, and patients are responsible for certain deductible and coinsurance payments.
Persons enrolled in the Original Medicare Plan who want prescription drug coverage must join a Medicare Prescription Drug Plan as described below, unless they already have drug coverage from a current or former employer or union that is at least as good as the standard Medicare prescription drug coverage.
When a patient receives hospital insurance benefits, he or she is billed by the hospital only for the deductible amount, any coinsurance amount and any noncovered services. The remainder of the bill from the hospital, as well as bills for services in skilled nursing facilities or home health visits, is sent to Medicare to pay its share.
Claims for medical insurance benefits filed on behalf of railroad retirement beneficiaries in the Original Medicare Plan are generally handled by Palmetto GBA on a nationwide basis. Palmetto GBA is a private company that contracts with the RRB and Medicare to pay Part B claims for railroad retirement beneficiaries, and can be reached at:
|Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
Many private insurance companies sell insurance, called Medigap for short, that helps pay for services not covered by the Original Medicare Plan. Policies may cover deductibles, coinsurance, copayments, health care outside the United States and more. Generally, individuals need Medicare Part A and Part B to enroll, and a monthly premium is charged.
When someone first enrolls in Medicare Part B at age 65 or older, he or she has a 6-month Medigap open enrollment period. During this period, an insurance company cannot deny coverage, place conditions on a policy, or charge more for a policy because of past or present health problems.
More detailed information about Medigap policies is available in the publication Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.