What is Medicare Part B?
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.