What does Original Medicare cover?

What does Original Medicare Cover?

Medicare can seem daunting at times and if you are approaching your 65th birthday, it can feel like you have a target on your back with all the solicitations that you are receiving from health insurance companies. Now that you are getting ready to take the plunge into Medicare, we will help break down what to expect with costs and coverage. 


Original Medicare (Medicare Part A & Part B) is designed to help share the costs of your medical needs. This does not cover everything. For example, your medications that are prescribed by your physician are not covered by this type of Medicare. Medicare Part D is a separate insurance program to help offset your out-of-pocket costs. 


Medicare Part A & Medicare Part B cover in-patient hospital and out-patient services. Now each of these parts have deductibles that are needing to be met before Medicare will help share the cost. For example, if you are needing to stay overnight in the hospital, Medicare Part A will help with these costs after you have satisfied a deductible of $1,632 (2024) Now this deductible can be reoccurring in the year if you are hospitalized for more than one benefit period. (For full details visit cms.gov) One thing to note with Original Medicare, is that there is no out-of-pocket maximum, meaning you will continue to have medical bills with all your medical services. For an individual that does not have any chronic illness or seems to be “healthy” this may not seem like a big ordeal. Of course, we know as we age, our healthcare needs change. For example, maybe you are needing knee replacement and the following months you are needing rotator cuff surgery, how do they charge for these services? A great tool Medicare.gov has is their procedure price look up, Click here to see what typical cost of services are.

What am I needing to know?

Medicare — in its original form — will cover any procedure/visit that is deemed medically necessary and ordered by a licensed physician. Typically for an office visit, Medicare Part B will pay 80% of the cost after you have satisfied the yearly deductible of $240. (2024) Like Medicare Part A, there is no out-of-pocket maximum. In a good year, you don’t have many doctor visits, but in a year that you are needing more care, you will continue to receive a bill for every medical service that you receive. 

Get assistance from local experts!

Schatz Benefit Group are your Medicare experts. They have over 25 years of combined experience of assisting individuals just like you! They will educate you on each component of Medicare so you can take those next steps with confidence and not feel shocked when a new medical need arises in your life. Contact them today for a free no obligation consultation and get the answers to your personal questions.