What is Original Medicare?
Unless you choose otherwise, you will have Original Medicare. You can instead decide to get your Medicare benefits from a Medicare Advantage Plan, also called a Medicare private health plan. Remember, you still have Medicare if you enroll in a Medicare Advantage Plan. This means that you must still pay your monthly Part B premium (and your Part A premium, if you have one). Each Medicare Advantage Plan must provide all Part A and Part B services offered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care.
Original Medicare, Part A and Part B
Each year, you generally must pay a set amount (a deductible) for your health care before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance) for covered services and supplies. If you have Medicare Part A, you can generally get the covered services listed in Part A Benefits. If you have Medicare Part B, you can generally get the covered services listed in Part B Benefits. You usually pay a monthly premium for Medicare Part B. You generally don’t need to file Medicare claims. Providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers are required by law to file Medicare claims for the covered services and supplies you get.
What’s Medicare Supplement Insurance (Medigap)?
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Are Dermatology Services Covered by Original Medicare?
Medicare Part B generally covers doctor services when they are medically necessary to evaluate, diagnose, or treat a medical condition. So if you’re going to a dermatologist to treat a medical skin condition, your visit will probably be covered. For most doctor visits, you pay 20% of the Medicare-approved amount if your health-care provider accepts assignment.
Original Medicare (Part A and B) Eligibility and Enrollment
To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Original Medicare vs. Medicare Advantage
Medicare Advantage (MA, also known as Part C) plans are sold by private insurance companies. In order to be eligible to join one, you must already have Original Medicare. MA plan enrollment occurs either through your Initial Enrollment Period (when you first sign up for Part A and Part B) or during the Annual Election Period, which runs from October 15 to December 7 each year. If you are diagnosed with ESRD, you can only join a MA plan in certain situations and may be able to join Medicare Special Needs Plan (SNP) if one is available in your area. Remember, even if you are enrolled in an MA plan, you will still need to keep paying your Part B monthly premium.
Medicare Information, Help, and Plan Enrollment
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.