One of your Medicare health plan choices can be the original Medicare Plan. You must remain on this plan unless you elect to enroll in either the Medicare Advantage Plan or any of the other Medicare Health Plans that are available.

The original Medicare Plan is managed by the federal government and is a fee-for service plan. Your health card will be your original red, white and blue Medicare card. You can use any physician that accepts Medicare, but check and make sure they are accepting new Medicare patients. Your monthly payment for Medicare Part B will be a set amount and Medicare will pay its share for covered services and supplies.

Once you have chosen a health care service, they will send you a monthly Medicare summary notice in the mail. This notice will provide you with additional information and will also list the services you have received and the amount you may be billed for these services. You might receive two of these notices if you received any drugs covered by Medicare part B drugs, which would include certain cancer drugs. One of these notices will be for your doctor's visit and the second will have the drug company information. This notice will inform you if your claim for the drug is approved or not. It is possible to file an appeal if you disagree with the statements.

Your out-of-pocket costs depends on several different conditions: a) if you have part A or Part B (Most people have both), b) How often you need to be treated by a physician or hospital, c) whether your doctor accepts Medicare patients under assignment, d) the type of treatment needed, or if you have additional health insurance benefits that work with Medicare. If you choose services that are not covered by Medicare you would pay all expenses yourself or look for a Medicare supplemental insurance policy.

Your Original Medicare Plan costs in 2005

If you have Medicare Part A or Part B you will be expected to pay a part of the bill for any medical treatment you receive. As with most health insurance policies, there are co-insurance and co-payments required for most office visits, hospital stays and other medical treatments. Here is a list of some of the costs you will be expected to pay. Note: These are 2005 costs. 2006 had not been listed at the time this list was compiled. NOTE: It is known that in 2006 there may be limits on physical therapy, occupational therapy and speech-language services.

• Medicare Part B deductible: You pay the first $110 per year
• Hospital stays of 1-60 days: You pay $912.00 per benefit period
• Hospital stay of 61-90 days: You pay $228.00 per day
• Hospital stay of 91-150 days: You pay $465.00 per day
• Hospital stay of over 150 days: You pay all costs for each day
• Skilled nursing facility stays for the first 20 days: You pay $0
• Skilled nursing facility stays for 21-100 days: You pay $114.00 per day
• Skilled nursing facility stays after 100 days: You pay all costs
• Doctor visits, outpatient therapy, preventive care and DME: You pay 20%
• Home health services: You pay $0 if Medicare approved
• Clinical laboratory: You pay $0 if Medicare approved
• Outpatient mental health services: You pay 50%
• Blood, inpatient first three pints: You pay 100%
• Blood, outpatient first three pints: You pay 100%
• Blood, outpatient, pints over first three: You pay 20%

You are also expected to pay co-payments and coinsurance amounts for other services that are not included in the list above.

Original Medicare Plan Assignment

Assignment is an agreement between patients with Medicare, their doctors and other providers with Medicare. When you have Medicare, you will agree to let the doctor bill Medicare for payment. Doctors or providers cannot try to charge more than the Medicare deductible and coinsurance amounts. Physicians can not overcharge you any other insurance you may have or anyone else.

If assignment is not accepted, physicians and providers may charge more than the amount approved by Medicare. Even without assignment there is a limit on the amount that these physicians can charge you. This is called the "limiting charge" and has a 15% maximum over Medicare's approved amount The limiting charge is only for certain services and will not apply to supplies and other items that are not included under the list of "limiting charges" applied health care services. If you are visiting a physician that is not "Medicare assigned" you may have to pay the entire charge at the time of service. You will then need to file a claim to Medicare and they will send you its portion of the charge when your claim in entered. Physicians that are not Medicare assigned are not obligated to file claims on your behalf.

The same type of Medicare assignment rules apply to obtaining prescription drugs from a pharmacy. If you get Medicare Part-B covered prescriptions from a pharmacy that is enrolled in the Medicare program, the pharmacy must accept assignment. If you get your Medicare Part-B prescriptions form a pharmacy that is not enrolled in the Medicare program you will have to file your own claim to Medicare in order for them to pay. If you use glucose test strips, all enrolled pharmacies and suppliers must submit the claim for you and cannot charge you for this service.

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