If you’re new to Medicare, chances are you’ll start with what’s called Original Medicare—the traditional, government-run program. It’s a solid foundation for your healthcare, but like anything, it has its ups and downs. Let’s break it down so you can decide if it’s the right fit for you.
What is Original Medicare?
Original Medicare is split into two main parts- Medicare part A&B:
- Part A (Hospital Insurance): Covers big-ticket items like hospital stays, skilled nursing care after a hospital stay, hospice care, and some home health services. Think of it as your safety net for major medical events.
- Part B (Medical Insurance): Handles your day-to-day medical needs, like doctor visits, outpatient care (X-rays, lab tests, etc.), medical supplies, and preventive services like annual wellness visits.
The PROS of Original Medicare
Here’s why many people love Original Medicare:
1. Freedom to Choose Your Doctors and Hospitals
This is a huge perk! With Original Medicare, you can see almost any doctor or visit any hospital in the U.S. that accepts Medicare. No networks, no referrals—just freedom. If you have favorite doctors or travel often, this flexibility is a game-changer.
2. Nationwide Coverage
Whether you’re in Asheville, the Outer Banks, or visiting family in another state, Original Medicare works the same way everywhere. Your coverage travels with you, giving you peace of mind no matter where you are.
3. No Prior Authorization for Most Services
Need a test or treatment? With Original Medicare, you usually don’t need to get approval beforehand. This makes accessing care simpler and faster.
4. No Annual Plan Changes
Unlike some private plans, Original Medicare doesn’t require you to re-evaluate your coverage every year. While costs and covered services may adjust slightly, the core of your plan stays the same.
The CONS of Original Medicare
Of course, no plan is perfect. Here are some of the downsides:
1. It Doesn’t Cover Everything
Original Medicare leaves out some pretty important things, like:
- Routine dental care (cleanings, fillings, dentures)
- Routine vision care (eye exams, glasses)
- Routine hearing care (hearing aids, tests)
- Most prescription drugs
- Long-term care (like nursing home stays for daily living help)
- Cosmetic surgery
If these are must-haves for you, you’ll need to look into additional coverage.
2. No Yearly Out-of-Pocket Limit
This is a biggie. With Original Medicare, there’s no cap on how much you might pay in a year. If you face a serious illness or accident, those deductibles, copayments, and coinsurance costs can add up fast.
3. You’ll Likely Need More Coverage
Because of these gaps, most people add:
- Medicare Part D (Prescription Drug Plan): To help cover medication costs.
- Medicare Supplement (Medigap) Plan: To help pay for deductibles, copayments, and coinsurance.
What Does This Mean for You in North Carolina?
If you’re healthy and don’t mind juggling a few different plans (Original Medicare + Part D + possibly Medigap), this option might work well for you. It offers unmatched flexibility and nationwide coverage.
However, if you’re looking for an all-in-one plan with extras like dental, vision, and a yearly cap on out-of-pocket costs, you might want to explore Medicare Advantage -Part C instead.
How to Decide
The best choice depends on:
- Your health needs: Do you have ongoing medical conditions or frequent doctor visits?
- Your budget: How much can you afford for premiums and out-of-pocket costs?
- Your lifestyle: Do you travel often, or do you stay local?
- Your doctor preferences: Do your current providers accept Medicare?
Take the Confusion Out of Medicare with the Mair Agency
Medicare can feel overwhelming, but it doesn’t have to be. The Mair Agency is your go-to resource for understanding Medicare and making confident decisions about your coverage.
Whether you’re just starting to explore your options or need help navigating the details, the Mair Agency offers:
- A Medicare for Beginners guide to break down the basics in simple terms.
- A free video course for visual learners, walking you through everything you need to know.
- In-person Medicare seminars led by experts, where you can ask questions and get personalized advice.
With over 30 years of experience, the Mair Agency is dedicated to helping you understand your options and find the plan that fits your needs. Don’t let Medicare confusion hold you back—visit the Mair Agency today and take the first step toward stress-free coverage!
