The Ultimate Guide to Original Medicare

What is Original Medicare?

Medicare is a federal health insurance program for:

• People 65 and older
• Certain younger people with disease
• People with end-stage renal disease

Original Medicare includes two parts: Part A (hospital insurance) and Part B (medical insurance). After you pay your deductible, Medicare will pay its share of the Medicare-approved amount, and you your share (coinsurance and deductibles).

Because Medicare does not cover everything, you can choose to improve your coverage with a Medicare supplement, which picks up some or all of the costs not covered by Original Medicare. Alternatively, you could choose to replace Original Medicare with a Medicare Advantage plan. A Medicare Advantage plan is issued by a private company. It usually offers some benefits not covered under Original Medicare, but also usually comes with limitations, such as limiting your choice of doctors to a specific network. You can’t have both a Medicare supplement plan and Medicare Advantage plan.

Part A (Hospital Insurance)

Medicare Part A covers the following types of care:

• Inpatient hospital stays
• Skilled nursing facilities
• Nursing homes
• Home health care

In most cases, you will not pay a premium for Part A, provided you or your spouse paid Medicare taxes for a specified amount of time. If you do not meet that minimum requirement, you may be able to purchase Part A. The cost will depend on how long you paid into Medicare.

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Part B (Medicare Insurance)

In general, Medicare Part B covers two types of services—those that are medically necessary and those that are preventive.

Medically necessary services include:

• Care by certain doctors
• Outpatient care
• Durable medical equipment
• Clinical research
• Ambulance services
• Mental health
• Limited outpatient prescription drugs

Some of the preventive services Medicare Part B covers include:

• Shots and vaccines
• Wellness visits
• Diabetes-related services
• Tests and screenings
• Counseling and therapy
• Mental health service

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What does WPS Medicare supplement insurance (Medigap) cover?

WPS Medicare supplement plans help you cover the 20% of out-of-pocket expenses that Medicare usually leaves behind after you pay your deductible.

With WPS Medicare supplement insurance:

• There are no networks, so you have freedom to visit any doctor, specialist, or facility that accepts Medicare at home and when traveling nationwide.
• No referrals are necessary to see a specialist.
• Stable rates help create peace of mind.¹
• Your plan moves with you wherever you live in the United States.
• You get unlimited preventive care with base plan coverage.²
• You have less paperwork and fewer worries with our automatic claims service.
• You receive a gym membership at a local fitness club at no extra cost, available through the Silver&Fit^® Healthy Aging and Exercise Program (not available with cost-sharing plans K and L).³
• Enjoy discounts on acupuncture, massage therapy, nutritional counseling, and much more through ChooseHealthy^®.³
• You get the EyeMed vision care program and the Hearing Care Solutions hearing program at no extra cost.⁴
• You can choose optional foreign travel emergency coverage up to $100,000.⁵

Part D (Drug Coverage)

You can add a Medicare Part D plan, which covers prescription drugs, to Original Medicare. Your Medicare supplement plan works together with your Part D plan to help make prescription drugs more affordable. Some types of prescription drugs, such as those that treat cancer or HIV/AIDS, must be covered by all Part D plans. Plans usually cover many other types of prescription drugs, as well. You can find a complete list in the plan’s formulary.