Original Medicare:
What It Does and Doesn’t Cover

Original Medicare includes two parts: A and B. The reason it’s called Original Medicare is because Parts A and B used to be the only Medicare coverage available until they added Part C (Medicare Advantage) and Part D (prescription drugs) later on.

Medicare Part A helps pay for medically necessary care that requires a stay in the hospital or at a skilled nursing facility. It also covers hospice care for the terminally ill and some skilled home health care.

Medicare Part A is free if you or your spouse have paid into Social Security for 10 or more years. However, it does come with a deductible per hospital stay for each “benefit period.” This period begins when you’re admitted to the hospital and ends when you’ve been out of the hospital for 60 days in a row. After that, what you pay changes depending on the length of your stay.

Length of Hospital Stay You Pay
Days 1-60 $1,600 deductible then nothing
Days 61-90 $400 per day ($389 per day 2022)
After 91 Days $800 per day ($778 in 2022)
(this will only be paid for once in your lifetime)
Beyond Lifetime Reserve Days All costs
No limit on out-of-pocket costs

Source: Medicare.gov.

These coverage amounts are for 2023 and may change from year to year.

Medicare Part B helps pay for medical care, including Doctor office visits, lab tests and screenings, and some skilled nursing care at home, as well as the Doctor services you receive when you are in the hospital.

Medicare Part B comes with a small deductible. You must also pay a monthly premium for Part B, which increases based on your income.

Medicare Pays You Pay
80% of medical care costs (once deductible is met) $233 Deductible
$164.90 monthly premium ($170.10 in 2022)*
Prescription Drug Coverage: Varies by Plan*
20% of all medical care (once deductible is met)
No limit on out-of-pocket costs

Source: Medicare.gov.

These coverage amounts are for 2023 and may change from year to year.

*Can vary based on income and potentially how long you’ve been enrolled in the Medicare program.

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BayCare Select Health Plans is an HMO plan with a Medicare contract. Enrollment in BayCare Select Health Plans depends on contract renewal. All BayCare Select Health Plans include Part D drug coverage.

To enroll, you must have both Medicare Parts A and B and reside in the plan service area.

You must continue to pay your Medicare Part B premium. Enrollment in a BayCare Select Health Plan may be limited to specific times of the year.

Members must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from BayCare Select Health Plans, neither Medicare nor BayCare Select Health Plans will be responsible for the costs.

Information on our utilization management processes, including prior authorization, concurrent review, post service review and appeals, can be found online at Member.BayCarePlus.org.

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