Traditional or Original Medicare – What’s The Difference?

Hello, thank you for listening to this Medicare Moments podcast. Hi, I’m Toni King. I took the Medicare and You handbook that many find hard to understand. I put it into “people terms.” I helped America personalize their Medicare because, with Medicare, it’s what you don’t know that will hurt you. So today, on Medicare Moments podcast, we’re gonna talk about original or traditional Medicare. What is the difference? I will tell you, so let’s get started together. I write an article each week in the local newspaper in Houston, Texas. Here’s a question from one of my readers. A question from Sam. Sam says: “I have been reading your column for over a year, and now I need some Medicare help. I’m retiring and turning sixty-five in October. I had a triple bypass January of this year. Last week, I went to my doctor’s office and talked with the office manager. I’m at the cardiologist’s office and trying to figure this out. I’m talking to her about what I need to do to get on Medicare, and what should I do? What plan should I pick? She said for me to enroll in traditional Medicare. I have no idea what traditional Medicare is. Can you please explain this? I really do not want to enroll in the wrong plan. Can you help me shape what my Medicare is going to be for the future? Thank you. This is Sam from Houston, Texas.” So, if I were Sam, I would probably be thinking, “How am I going to be able to get insurance now? Do I qualify? And what exactly is Medicare all about?” Well, Sam. All I can say is, “Let’s just make this simple for you.” I talk with everyone each week on Medicare, and you know, America is so confused. I have consulted with people every day. I even have people that have PhDs that come in the office, who have higher education, and understanding Medicare just brings them to their knees. They are so frustrated and confused. You know, this seems to make a grown man want to cry. I understand how confused you are, Sam, because I see it every day. So, let’s examine just what is traditional or original Medicare. You know we’re gonna do this together, you and I. Most healthcare professionals call Medicare “traditional Medicare,” but Medicare refers to it as “original Medicare.” Guess what, Sam? You will not find traditional Medicare anywhere in the Medicare.gov website, or in the Medicare and You handbook. It’s nowhere! All they call it is “original Medicare.” It’s the same thing. The healthcare professionals call it “traditional Medicare.” Medicare consists of only Medicare Parts A and B. None of the other alphabet soup letters—not any of it—not Medicare Part C or D. You can go to the doctor, and they’ll ask you do you have your Medicare cards. You know, it’s your red, white and blue card. Your Medicare card. Original Medicare. And that’s what we’re talking about. So, Sam— like I said, we’re gonna discuss this together. We’re gonna go down the Medicare trail together. There is not a network with original or traditional Medicare. You go to the doctor, and your claim gets paid. You do not have to search for a network, online or offline. There is no network. Repeat that, Sam. Repeat that, America. There is no network with original or traditional Medicare. Most people are used to a network. This is how insurance used to be back in the day. So, Sam—let’s discuss the different parts of original and traditional Medicare. That is Part A, and that is Part B of Medicare. We’re gonna do this together, both you—Sam—me and America. We’re going to discover this together. You know what? Medicare was started July 30th, 1965 when President Johnson—Lyndon Baines Johnson—flew to Independence, Missouri to sign Medicare and the Law in front of President Harry Truman. Truman worked for twenty years to get Medicare started. So Medicare’s Part A and B began on July 30th, 1956, and healthcare for those who are sixty-five on Medicare have never been the same. So let’s discuss the different parts that you’re looking at, Sam—Medicare Part A and Medicare Part B. Here we go. Medicare part A is called “inpatient hospital insurance.” It is for those having an inpatient hospital stay. It doesn’t have anything to do with outpatient surgery. It is inpatient. Medicare Part A’s deductible for 2022 is 1,056 dollars—not once a year, but six times every sixty days. Medicare Part A, every sixty days, repeats itself. It is six times a year deductible. Skilled nursing, which is part of Medicare Part A, has a zero co-pay from days one through twenties, so you pay nothing when you go into a skilled nursing facility for the first twenty days. And then after that, days twenty one through one hundred. Guess what? There is a hundred and ninety-four dollar and fifty cent co-pay per day. And after day one hundred and a skilled nursing facility, guess who pays for everything? Medicare will not pay. The individual who’s in the skilled facility will pay. That’s where long-term care comes in to help you out. So Medicare Part A also includes hospice and home health, and both of those have a zero deductible—or zero co-pay. Now, let’s—let’s discuss what is Medicare Part B. That is what Medicare calls the “medical insurance” part of this, and most people use more Medicare Part B than they do Medicare Part A, which is your inpatient hospital stay. Medicare Part B, which is medical insurance, has a premium—which is a hundred and seventy dollars and ten cents. This is income based. The more you make, the more you’re gonna pay. Americans with income under 91,000 dollars as an individual, someone who is single, or someone who is filing their taxes on their own—then your Part B premium will be the hundred and seventy dollars and ten cents. If your income is under a 182,000 dollars as couple, husband and wife, then your Part B premium will be a hundred seventy dollars and ten cents each month. You are either going to pay this through your Social Security check, if you are receiving Social Security. Or you’re going to have to pay this directly to Social Security, who does all the paperwork for Medicare. That’s where this is going to be paid. So the more you make, the higher your premium can be. And we can discuss that in future Medicare Moments podcasts. One must enroll in Medicare the correct way, especially after turning sixty-five and still working. And that is another podcast, another Medicare Moments podcast which we will have in a few weeks. Medicare Part B covers medically necessary services. Such as, doctor charges—which are for the office visits, your doctor doing surgery, whether it’s an inpatient hospital stay or an outpatient hospital stay. Other outpatient hospital services. Tests. Durable medical equipment. You need to get a wheelchair or a walker. Diabetics supplies. Oxygen. All of that is covered under Part B, and other medical services that are mentioned in the Medicare and You handbook. Medicare Part B has a one time a year deductible, which is two hundred and thirty-three dollars for 2022. Medicare will pay the eighty percent of the Medicare-approved amount, and you will pay the twenty percent of the Medicare-approved amount. So you—you’ll still have some out-of-pocket. The twenty percent. A Medicare provider can charge you 1,000 dollars for a service, but Medicare might approve this at six hundred and twenty-three dollars. Guess what? It’s a six hundred and twenty-three dollars that the twenty percent is applied to—not the 1,000 dollars that your doctors sent as a bill. So, how do you pay for the twenty percent? What do you do? You know, Sam—I’m sure you’re concerned, because you may have some medical bills, and you don’t want to have to have twenty percent out-of-pocket. So how can you pay for this? That is where a Medicare supplement or a Medigap policy that works only. Now, get this—it works only with original or traditional Medicare, and it does have a premium. So you’ll have to pay for your Medicare supplement or Medigap, as it’s also known. You’ll have to pay for the premium. And there’s different plans. Each company has different costs, and we can discuss the Medicare supplement in future podcasts. So, Sam, don’t feel alone. There are over 10,000 baby boomers entering Medicare every day for the next twelve years. Not 10,000 entering every year, but entering every day. People are turning sixty-five, over 10,000. Can you imaginethat? Turning sixty-five every day for the next twelve-plus years. Most are completely stressed and confused, so don’t feel alone. So, let’s go over some of the basics, some of the Medicare facts that—that you really need to know. Number one, you’re gonna want to enroll in Medicare on time. People need to figure out: Are they getting their Social Security check? If that’s the case, then your Medicare will start automatically. When you turn sixty-five, your Medicare will start the first day of the month that you’re turning sixty-five. Maybe you’re someone who’s not receiving your Social Security check. What should you do to enroll? That is a person who has to go online and enroll at socialsecurity.gov and enroll in Medicare. We do that at our office all the time for people. That’s what we do. We consult with people and help them understand when to enroll in Medicare. Maybe you’re someone who is working full-time. You have workplace insurance. You don’t know what to do, so we can help you. Through more podcasts, you will begin to understand what you need to do to enroll. So there’s three different ways to enroll. Number one, someone turning sixty-five and receiving their Social Security check. Poof—automatically, they’re going to receive their “Welcome to Medicare” kit. Number two, people who are not receiving their Social Security check. And—and maybe they’re self-employed and they want to enroll in Medicare. Or maybe their company insurance has a high deductible, and they think, “This is just too expensive. I can’t handle it.” So they need to go online to socialsecurity.gov and enroll in Medicare. So number three are people who are still working, and they have workplace insurance. They have company benefits, and they want to know, “What do I need to do if I’m leaving my work? I have not enrolled in Medicare.” Maybe you are seventy, seventy-two, and you’re coming off your job. And you want to know, “What do I need to do? I have not enrolled yet.” There’s different rules in regards to that. So here’s fact number two: Medicare is not free. People think Medicare is free because Part A has no cost to it. Well, it doesn’t have a cost to it because you pay tax dollars. That’s why it is a no-cost situation. Medicare is not free. You have to work ten years, or forty quarters, to get Medicare Part A at no cost. Your Medicare Part B does have a premium. It’s not free, because you’re having to pay something. And number three, people need to learn their alphabet soup. So here’s Medicare fact number three: alphabet soup. What is Medicare Part A, which is inpatient hospital? What is Medicare Part B? That is, your medical. That is your wheelchairs and your walkers and your durable medical equipment. It’s your going to the doctor. It’s your doctor doing surgery. It’s your outpatient surgery. It’s getting your cataract surgery. That’s all done under Part B of Medicare. Medicare Part C is your Medicare Advantage Plan, and Medicare Part D is your prescription drug plan that people get totally confused about. And we’re gonna have some Medicare Moment podcasts to discuss the doughnut hole and what is Medicare Part D—get a little deeper into this. And number of four is, Medicare doesn’t cover everything. You have to realize: Medicare will only cover medical services. Your original Medicare—Medicare Part A and Medicare Part B. It does not cover your glasses, it does not cover hearing aids, and it does not have dental benefits. And number five is, how to make the most of your Medicare. You need to schedule a screening. Those are very important. Wellness visits, preventative visits—all of those are very, very important. So you know, for more information regarding what is original or traditional Medicare—it is explained in my Medicare Survival Guide: Advanced Edition, which is available at my website. Which is: www.ToniSays.com. So, I hope you understand what is original and traditional Medicare, because they are both the same thing. And remember—there is no network in Medicare. You can go to any hospital and doctor outpatient surgery facility that is accepting Medicare. So you don’t have to look for a network, and you also may want to look into a Medicare supplement down the road. So I would like to thank all of y’all for listening to this Medicare Moment podcast. If you still have questions about personalizing your Medicare just for you, making it just for you, if you would like to find out more, then email me at [email protected] Or visit my website—which, as I said, was ToniSays.com. Now, that’s ToniSays.com. And y’all go have a great day, and until the next time, talk to you later.