Here in the UK we are fortunate to have the NHS – however there is nothing like it in the USA.  However, as a federal insurance program, Medicare was designed to significantly contribute to ensuring healthcare coverage and financial security for the elderly population in the USA.

Its wider reach is demonstrated by the fact that Medicare offers health insurance to people 65 and older and those who meet eligibility requirements because of a handicap. Original Medicare, often called standard Medicare, refers to the original Part A and Part B of the Medicare program, which were required by legislation that President Lyndon B. Johnson signed into law in 1965.

 

• Part A helps to pay for costs associated with hospital admissions, care given in nursing homes, some services provided at home, and hospice care for those nearing the end of their lives.

 

• Part B discusses expenses for paying medical professionals, diagnostic tests, lab analysis, outpatient care, preventative treatments, medical supplies, and transportation.

 

Medicare eligibility is not dependent on income or assets, protecting people from potential coverage denials or increased expenditures due to pre-existing conditions. You can select any healthcare professional or specialist from the extensive network covered by original Medicare anywhere in the country. Over 95% of surgeons, 90% of non-pediatric doctors, 80% of other highly trained medical specialists, and 60% of psychiatrists are willing to accept new Medicare patients, which is an astounding majority.

 

How much will it cost US Citizens for original Medicare?

Medicare is not provided without cost. You’ll notice that original Medicare has expenses similar to the premiums for private insurance plans, which were probably paid for during your employment history.

Part A premiums for Original Medicare beneficiaries are typically unnecessary if they or their spouse had Medicare taxes deducted from their paychecks for 40 quarters, equal to ten years of employment, not necessarily consecutively. However, paying Part B premiums is a requirement for practically everyone. Although people with higher salaries might expect higher rates, the average monthly cost is $170.10 in 2022 and $164.90 in 2023.

A predefined out-of-pocket payment known as the deductible must be paid before your Medicare coverage takes effect. After your deductible has been met, a set payment, such as $20, may be required for some services and supplies.

Like the copayment system, coinsurance requires you to pay a predetermined proportion of some costs after reaching your deductible. For many Part B treatments, this percentage is often 20%.

While it’s important to understand that Medicare provides necessary healthcare coverage, costs are also connected with these advantages.

 

Is buying supplemental policies a necessity for Medicare members?

Original Medicare provided extensive coverage for medical costs, but it had several limitations. If you discover that you require extra regulations to cover particular issues:

Coverage for Prescription Drugs: Original Medicare does not include coverage for prescription drugs, but you can fill this gap with a Part D policy from a private insurer. You must enroll in Part D if you don’t already have “creditable coverage,” defined as having health insurance that is comparable to Medicare’s drug coverage. A late enrollment fee could apply if you don’t do that.

Medigap Insurance: Medigap insurance often covers the deductibles and copayments associated with basic Medicare. By filling in the gaps left by original Medicare, this supplemental coverage.

Private insurance companies offer you the freedom to buy these plans whenever possible. It’s crucial to remember that in most states, insurers have the right to deny your application or increase your premium due to preexisting medical issues if you don’t enroll in coverage during particular enrollment periods.

 

What are the differences between original Medicare and Medicare Advantage?

The government-managed Original Medicare and the Medicare Advantage plans provided by third parties are the two options for coverage that Medicare offers. These choices show considerable disparities.

You can obtain medical care from any doctor, provider, or facility in the United States that accepts it under Original Medicare, which the federal government governs; no specialist’s consent is necessary. You must pay deductibles and copayments for Parts A and B, and prescription drug coverage is offered on a conditional basis.

A Medicare Advantage plan, on the other hand, gets its coverage from a private insurance company even though you enroll for Part A and B through the government. These plans must at least provide fundamental Medicare coverage, even though their out-of-pocket expenses may vary. They also require payment of the Part B premium.

Additional coverage that Original Medicare does not provide, including dental, hearing, prescription drug, and vision coverage, may be included in Medicare Advantage plans. Utilizing providers outside this network may result in higher costs or loss of coverage because most Advantage plans operate within a provider network. The plan’s administrators might need to give their prior consent for you to see a specialist.

When signing up for Medicare Advantage, whether during the initial enrollment period or the annual open enrollment, you can choose from various nearby plans.

 

What to keep in mind

You might have to sign up for original Medicare at a specific time and fulfill the requirements depending on factors like receiving Social Security benefits and the employment status of you or your spouse.

A few enrollments happen automatically. Medicare Parts A and B enrollment begins on the first day of the month you turn 65 if you begin receiving Social Security benefits at least four months before that date. Your Medicare coverage starts on the first of the month if your birthday falls on that day.

Some people have to self-enroll. You can enroll during the initial enrollment period, which lasts seven months and starts three months before your 65th birthday and ends three months after that month. You can enlist as early as February 1 or as late as August 31 if, for example, your birthday is on May 15.

Delays in enrollment may occur for some people. If you want to sign up after turning 65, you can be charged a late-enrollment penalty unless you or your spouse still work and have health insurance through your current workplace. In such circumstances, you may postpone enrolling in Parts A and B until eight months after you or your spouse has left your position, ending your access to that employer-based coverage.

 

Medicare does offer some advantages for residents over other healthcare plans – but it is nothing like the comprehensive free healthcare that UK residents enjoy.