Doctor’s Advice…Get Traditional Medicare…What’s That?

Good Morning Toni:     

Have been reading your column for over a year and now I need some Medicare help.  I am retiring and turning 65 in October.  I had a triple bi-pass in April 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 “Traditional Medicare” is?

Could you please explain this and make it easy to understand?  I do not want to enroll in the wrong plan and help me shape my Medicare.  Thank You, Samuel

Hello Samuel:

I will make this as simple as I can.  I have consulted with confused Americans who have a PHD in higher education and understanding Medicare just frustrates them.  It can make a grown man want to “cry”!

I sense confusion on this subject because doctor’s office managers advise current patients to enroll in “Traditional Medicare”.  Let’s examine just what “Traditional Medicare” is and we will do this together.

Most healthcare professionals call Medicare, “Traditional” Medicare, but Medicare refers to it as “Original” Medicare. You will not find “Traditional” Medicare anywhere in 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/Traditional Medicare is also known as your Medicare card or as many on Medicare refer it as the “red, white and blue card”.

There is not a network with “Original/Traditional” Medicare and this is very hard for those who have retired with employer group health insurance to understand, “NO Network”!      If your hospital, doctor, or healthcare provider accepts Original Medicare or Medicare assignment, then they will accept Traditional Medicare because both are the same thing.

Original/Traditional Medicare… Parts A and B are explained below:

MEDICARE PART A (In-patient Hospital Insurance) comes at no cost. Part A is for an in-patient hospital stay.   Part A deductible for 2020 is $1,408 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 $1408.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $176 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) has a premium of $144.60 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 $198 for 2020. Medicare pays 80% of the Medicare approved amount and you or will pay 20% of the Medicare approved amount.  A Medical provider may charge $1,000.00 for a service, but Medicare may approve $623.00, it is the $623.00 that the 20% is applied to.

If you see a doctor who does not accept Medicare-approved amounts, you will pay more-possibly up to full cost for the doctor’s visit and care. Original/Traditional Medicare is expanded on in my Medicare Survival Guide® Advanced edition available at www.tonisays.com.

A Medicare Supplement works only with Original/Traditional Medicare and does have a monthly premium based on which Medicare Supplement plan one selects.

Toni King, author of the Medicare Survival Guide® Advanced edition is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com.