Traditional or Original Medicare, What’s the Difference?
“I am retiring and turning 65 in October. I had a triple bypass in January of this year. 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 that is! Could you please explain this and make it easy to understand? I do not want to enroll in the wrong plan!”
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I will make this as simple as I can. I have consulted with confused Americans who have a Ph.D. in higher education and understand Medicare just frustrates them. It can make a grown man want to cry!
Let’s examine just what ‘Traditional Medicare’ is and we will do this together.
Traditional Or Original Medicare – What’s The Difference?
Most healthcare professionals call Medicare, Traditional Medicare, but Medicare refers to it as Original Medicare. You will not find Traditional Medicare anywhere on the medicare.gov website or in the Medicare & You handbook.
Original (or, Traditional Medicare) consists of only Medicare Parts A and B, and not the rest of the alphabet soup such as Parts C or D. Original Medicare is also known as your Medicare card or as many on Medicare refer it as the “red, white and blue card.”
There is no network with Original Medicare. If your hospital, doctor, or healthcare provider accepts Original Medicare, then they will accept Traditional Medicare because both are the same thing.
Original Medicare Parts A & B Explained
Medicare Part A, Inpatient Hospital Insurance
Medicare Part A is for an inpatient hospital stay. Part A’s deductible for 2024 is $1,656 and has 6 deductibles in a year. Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1,656. Skilled nursing has a $0 co-pay for days 1-20, but from days 21-100, there is a $198.50 co-pay per day. After day 100 in a skilled nursing facility, you pay the cost. Medicare Part A also includes hospice and home healthcare with a $0 co-pay.
Medicare Part B, Medical Insurance
Medicare Part B has a premium of $170.10 which is based on income. One must enroll in Part B the correct way especially after turning 65 and “still working”. Part B covers “medically necessary” services such as doctor charges for office visits, surgery for inpatient or outpatient hospital stays, outpatient hospital care/services, tests, durable medical equipment, and other medical services. Part B has a yearly one-time deductible of $255 for 2024. Medicare pays 80% of the Medicare-approved amount and you or will pay 20% of the Medicare-approved amount. A Medical provider may charge $1,000 for a service, but Medicare may approve $623. It is the $623 that the 20% is applied to.
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Originally published September 27, 2024
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