Traditional (original) Medicare Explained

Medicare explained

What is Original Medicare?
  • It is the traditional fee-for-service program offered directly through the federal government. Under Original Medicare, the government pays directly for the health care services you receive.
  • Original Medicare covers 80% of medical expenses. Clients are responsible for the 20%.
  • This includes Part A and Part B coverage if you enroll in both.
  • There is also Medicare Part D (Drug coverage) and an optional supplemental insurance that picks up the 20% that original Medicare does not cover.
  • Open Enrollment starts on October 15th to December 7th.

What does Part A cover?
  • In general part A covers: Hospital Care, Skilled Nursing Facility Care, Nursing home care (as long as custodial care isn’t the only care you need), Hospice, and Home Health Services.
  • Medicare as well covers services like lab test surgeries and doctor visits. Supplies such as wheelchairs and walkers are as well covered when medically necessary to treat a disease or condition.
  • There is no Part A premium (monthly fee).

What does Part B covers?
  • Medicare Part B covers 2 types of services:
    • Medically necessary services such as services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
    • Preventive services: Health care to prevent illness or detect it at an early stage.
  •  Part B as well covers things like: Clinical research, ambulance services, Durable medical equipment (DME), mental health (Inpatient, Outpatient, and Partial hospitalization), getting a second opinion before surgery, and limited outpatient prescription drugs.
  • According to Monthly Premium (fee) is based on your W2.
  • There is approximately a $185 yearly deductible and the monthly premium (fee) is approximately $144.30 depending on your income.

Medicare Part D and Supplemental insurance (optional)
  • Medicare Part D covers prescriptions. There are several plans available; you can choose one depending on the prescriptions you are currently taking. Monthly Premiums (fees) and deductibles vary depending on the plan you choose. Monthly premiums (fee) range from $15-$50. Yearly Deductibles may range from $300-$500.
  • Supplemental insurance (Medigap). This type of supplemental insurance helps pay your out-of-pocket costs in Original Medicare. Depending on the type of supplemental insurance you choose there is a monthly Premium (fee). It may vary from $80-$250/month.

To learn about costs and plans please visit to choose a plan to fit your needs.

Lakeside recommends Traditional Medicare for seniors age 75+.
Call Lisa Witt at 505-797-8735 to learn why.

Also always remember to consult with your doctor for proper diagnosis and treatment.