What is Medi­care Part B?

Record Observer - - Senior Satellite - By MIKE ZIM­MER

In last month’s ar­ti­cle, we ex­plored Medi­care Part A (hos­pi­tal in­surance) and talked about the in-pa­tient hos­pi­tal de­ductible and coin­sur­ances as­so­ci­ated with a pro­longed hos­pi­tal stay. In this ar­ti­cle we are go­ing to take a look at Medi­care Part B (med­i­cal in­surance) and the out of pocket costs as­so­ci­ated with Part B. To­gether, Medi­care Part A and Medi­care Part B are known as orig­i­nal Medi­care.

Medi­care Part B cov­ers med­i­cally nec­es­sary ser­vices and sup­plies needed for the di­ag­no­sis or treat­ment of your health con­di­tion. This in­cludes out­pa­tient ser­vices re­ceived at a hos­pi­tal, doc­tor’s of­fice, clinic, or other health fa­cil­ity. Medi­care Part B also cov­ers many pre­ven­ta­tive ser­vices to pre­vent ill­ness or de­tect them at an early stage. Medi­care Part B

Ben­e­fits Med­i­cal ser­vices and sup­plies cov­ered by Medi­care Part B in­clude (but may not be lim­ited to): Doc­tor’s Vis­its Lab­o­ra­tory Tests and XRays Chi­ro­prac­tic Care when ma­nip­u­la­tion of the spine is med­i­cally nec­es­sary to cor­rect one or more of the bones that have moved out of place in your spine(sub­lux­a­tion)

Home Health Ser­vices if you need skilled nurs­ing or ther­apy ser­vices. (Part Time/ In­ter­mit­tent Care – Not Long Term Care)

Am­bu­lance Ser­vices if your health re­quires am­bu­lance trans­port

Out­pa­tient Men­tal Health Ser­vices

Durable Med­i­cal Equip­ment if your doc­tor cer­ti­fies you need it and you buy or rent it from a Medi­care-cer­ti­fied sup­plier.

Pre­ven­ta­tive Ser­vices, such as pap tests, flu shots, screen­ings

Re­ha­bil­i­ta­tive Ser­vices, in­clud­ing phys­i­cal ther­apy, oc­cu­pa­tional ther­apy, and speech-lan­guage pathol­ogy ser­vices pro­vided by a cer­ti­fied ther­a­pist. Wel­come to Medi­care

Pre­ven­ta­tive Visit Dur­ing the first 12 months that you have Part B, you can get a “Wel­come to Medi­care” pre­ven­ta­tive visit. This visit in­cludes a re­view of your med­i­cal and so­cial history re­lated to your health, and ed­u­ca­tion and coun­sel­ing about pre­ven­ta­tive ser­vices, in­clud­ing cer­tain screen­ings, shots and re­fer­rals for other care, if needed. When you make an ap­point­ment, let your doc­tor’s of­fice know that you would like to sched­ule your “Wel­come to Medi­care” pre­ven­ta­tive visit. You pay noth­ing for the “Wel­come to Medi­care” pre­ven­ta­tive visit if the doc­tor or other qual­i­fied health care provider ac­cepts as­sign­ment.

If your provider per­forms ad­di­tional tests or ser­vices dur­ing the same visit that aren’t cov­ered un­der this pre­ven­ta­tive ben­e­fit, you may have to pay coin­sur­ance, and the Part B de­ductible may ap­ply. What is Medi­care As­sign­ment? An agree­ment by your doc­tor, provider, or sup­plier to re­ceive pay­ment di­rectly from Medi­care, to accept the pay­ment amount Medi­care ap­proves for the ser­vice and to not bill you for any more than the Medi­care de­ductible and coin­sur­ance. Medi­care Part B Costs You will pay both a monthly pre­mium and an an­nual de­ductible for Medi­care Part B. In 2016, most folks will pay $121.80 for their monthly pre­mium un­less you are al­ready re­ceiv­ing So­cial Se­cu­rity Ben­e­fits. In this case your Medi­care Part B Pre­mium will be the same as it was in 2015. You may also have to pay a higher pre­mium for Part B if your in­come is above a cer­tain amount. If you didn’t en­roll in Medi­care Part B when you were first el­i­gi­ble, you may have to pay a late-en­roll­ment penalty, un­less you’re el­i­gi­ble for a Spe­cial En­roll­ment Pe­riod. The an­nual Medi­care Part B de­ductible for 2016 is $166.

For in­di­vid­ual ser­vices and sup­plies, your Medi­care Part B costs will vary. Some pre­ven­ta­tive ser­vices are com­pletely cov­ered if your provider ac­cepts Medi­care As­sign­ment. If the Medi­care Part B de­ductible ap­plies, you must pay all costs un­til you meet the an­nual de­ductible amount be­fore Medi­care be­gins pay­ing its share. Af­ter your de­ductible is met, you typ­i­cally pay 20 per­cent of the Medi­care-ap­proved amount for the ser­vice. You may also owe a co­pay­ment for cer­tain out­pa­tient ser­vices.

Even though Medi­care Part B cov­ers a lot of ser­vices, you can still be left with sub­stan­tial out-of-pocket costs. A Medi­care Sup­ple­ment Pol­icy (Plans A-N) can help you fill in the “gaps” in cov­er­age that Medi­care Part B has. De­pend­ing on the plan you choose, a Medi­care Sup­ple­ment Plan can help you with the Medi­care Part B an­nual de­ductible of $166 and the 20 per­cent coin­sur­ance.

Have ques­tions re­gard­ing Medi­care or Medi­care Sup­ple­ment In­surance? Give me a call.

Mike Zim­mer is Pres­i­dent of Bay State In­surance Agency Ltd. in Cen­tre­ville, Mary­land. He may be reached at 410758-1680.


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