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About Group Insurance

Original Medicare is a federal health insurance program in the United States for individuals aged 65 and older, younger individuals with disabilities, and those with end-stage renal disease (ESRD). It includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Medicare Part A covers:

Inpatient hospital stays, Skilled nursing facility care, Hospice care, Some home health care services

Most people do not pay a premium for Part A, but there are deductibles, coinsurance, and copayments.

Medicare Part B covers:

Doctor visits, Outpatient care, Preventive services. Durable medical equipment

Part B requires a monthly premium, usually deducted from Social Security benefits, and also involves deductibles, coinsurance, and copayments.

Original Medicare does not cover all expenses. It excludes prescription drugs, routine dental and vision care, and long-term care. To fill these gaps, individuals can enroll in Medicare Part D (prescription drug plans) or Medicare Supplement Insurance (Medigap) plans.

Administered by the federal government, Original Medicare allows individuals to choose healthcare providers who accept Medicare. It's important to confirm with providers that they accept Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services.

Part A covers hospital services, including inpatient care, skilled nursing facility care (under certain conditions), hospice care, and some home health care. The Part A deductible refers to the amount that beneficiaries must pay out of their own pocket before Medicare starts covering the costs. This deductible is applied per "benefit period," which begins when a beneficiary is admitted to the hospital or a skilled nursing facility. The benefit period ends when the beneficiary has not received any inpatient hospital or skilled nursing care for 60 consecutive days.

Part B covers medical services such as doctor visits, outpatient care, preventive services, and durable medical equipment. The Part B deductible is the amount that beneficiaries must pay before Medicare starts paying its share for these services. Unlike the Part A deductible, which is applied per benefit period, the Part B deductible is an annual deductible.

is another important aspect of Original Medicare coverage. In addition to deductibles, beneficiaries may also encounter coinsurance costs when they receive medical services under Part A and Part B.

Under Part A, beneficiaries are responsible for paying coinsurance for certain types of inpatient care. Once the Part A deductible (if applicable) has been met for a benefit period, Medicare pays 80% of the approved amount for covered services, and the beneficiary is responsible for the remaining 20% coinsurance amount.

Part B of Original Medicare covers outpatient medical services, and beneficiaries are generally required to pay a coinsurance amount for these services. After the Part B deductible has been met (if applicable), Medicare typically covers 80% of the approved amount for covered services, and the beneficiary is responsible for the remaining 20% coinsurance.

Copay (or copayment) is another important aspect of Medicare coverage. It is a fixed amount that beneficiaries are required to pay for certain medical services and supplies covered by Medicare.

For Part A, beneficiaries may have to pay copayments for certain types of care received in an inpatient setting, such as a hospital or skilled nursing facility. As mentioned earlier, Part A has a deductible, and once that deductible is met, copayments may apply after a certain number of days in the hospital.

Under Part B, beneficiaries may have copayments for various outpatient services, including doctor visits, durable medical equipment, and other medical supplies.