Medicare Part B is the medical insurance component of Original Medicare, it pays for outpatient care such as trips to the doctors office and tests, like x-rays or MRIs. Unlike Medicare Part A, you are not automatically enrolled. Like any other insurance you will have to pay a premium, deductible, and copayment. Your Medicare care must also be necessary and provided at a Medicare-approved doctor’s office or facility. We will discuss the most important points about Medicare Part B in this article.
Getting Medicare Part B. It is actually easier to get Medicare Part B since it does not require any work credits. As long as you are a citizen, or legal resident for five consecutive years, and 65 years or older, than you can enroll.
How much does Medicare Part B cost? Medicare Part B requires that you pay a premium. In 2011, the premium was 96.11. This was the premium for about 75% of all Medicare Part B recipients. The lower premium applies to those who have their premium deducted from their social security check or who make less than $85,000 or $170,000 for married couples. For all others, the monthly premium is $115.40. The higher premium usually applies to individuals with gross income of at least $85,000 ($170,000 for married people). The premium includes a surcharge that increases with income. So for example, people who make $213,000 as a single person would pay an additional $253.70 surcharge.
What is covered by Part B. Like a regular health insurance, Medicare covers doctors bills that are medically necessary, including surgery and other outpatient care, whether done at a hospital or at the doctor’s office. Medicare Part B also covers laboratory testing and other outpatient care such as x-rays, injections (that are not self-administered), emergency room or regular clinic charges. Lab work, such as drawing blood or other tests, are covered so long as they are approved by Medicare. Medicare will pay for ambulances or any other transportation to the hospital as long it was medically necessary to do so. Nonemergency trips in an ambulance will not be covered.
Drugs that are self-administered are not covered by Medicare Part B, though Medicare Part D drug plans do cover prescriptions if you are enrolled. As discussed elsewhere, certain types of durable medical equipment are covered. Physical, speech, and occupational therapy are covered if it is prescribed by a doctor and regularly reviewed by him as well. There are limits to how much physical therapy will pay. I go over that in the next section. Medicare Part B will also cover podiatrists and some preventative screenings such as an annual physical, pap smears, colorectal cancer screening, screening for diabetes, and mammography (once yearly). Eye treatment is severely restricted. Medicare will only cover eye conditions based on an underlying physical problem, such as cataracts. Optometrist visits and eye glass prescriptions are not covered.
What does Medicare Part B pay? After paying monthly premiums and a yearly deductible of $162 (as of 2011), Medicare Part B will pay for health costs but only up to a certain point. First, Medicare places a value on medical services called the “approved amount” which may be lower than what a doctor’s office actually charges. Furthermore, Medicare only pays 80% of the approved amount leaving you to pay the remaining 20%. You may also be liable for up to 15% more in fees if your doctor does not accept “assignment”. This simply means that your doctor will accept Medicare’s approved amount. If he does not you may be charged a further “limiting charge” which is 15% more than the approved amount. But beware, by some weird loophole, there is no limiting charge for Part B services performed at a hospital. They can theoretically charge you as much as they’d like. Be certain to get all costs upfront and have a firm grasp of what you need to accomplish or you could be slammed with a large bill.
If you take away anything from this article it’s this: understand exactly what you need, who is going to provide it, whether it’s covered by Medicare Part B (or A, or Advantage, etc) and if not how will you cover it? Forewarned is forearmed, and with this knowledge you should be able to keep your health costs down at least to some degree.
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