Medicare Part B | What Does it Cover

What is Medicare Part B?

Medicare Part B:  Original Medicare has two separate parts: Medicare Part A, which covers hospital costs, and  Part B, which is your medical insurance. This post is going to tell you just about everything you need to know about Medicare Part B. We’ll look at what it costs, what’s covered (and what’s not covered), as well as how and when to enroll.  Call us if you have questions, 844-528-8688.  

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Medicare Part B in Brief

Medicare Part B covers the cost of your doctor's appointments, as well as the cost of preventative care and miscellaneous charges, such as ambulance rides. Medicare Part B is an optional form of coverage, so you may be automatically enrolled in this plan when you start receiving Medicare, but you can opt out of coverage.

What Medicare Part B Covers

 Part B covers the services that are medically necessary to treat illnesses, injuries, and the like, but which don't require a hospital stay. These services include:

  • Doctor's office visits
  • X-rays
  • Lab tests
  • Outpatient surgeries
Medicare Part B may also pay for mental health services and the cost of getting a second opinion before surgery. The plan also offers coverage for some outpatient prescription drugs (though most are covered by Medicare Part D).

Many preventative services needed for your overall health are covered under Medicare Part B, such as flu shots, hepatitis B shots, mammograms and other cancer screenings, diabetes testing, cardiovascular screening, and the like.

These treatments and tests are sometimes included in a what is called a "Welcome to Medicare" one-time visit, where they are covered as soon as you enroll in Medicare.

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Durable medical equipment that has been prescribed by your doctor is also typically covered by Medicare Part B. This would include wheelchairs, walkers, crutches, and so on. 

This equipment must be needed to treat a disease or condition. For example, grab bars that you might install in a bathroom just for added balance may not necessarily be covered by Part B.

 Additionally,  Part B may pay for specific, incidental services that are needed as part of your treatment and care. For example, Medicare Part B will usually pay the cost of ambulance services and outpatient care after a hospital stay. 

The plan may also pay for specific home health care services, physical therapy, and other rehabilitative services if these are deemed medically necessary by your doctor.

What Medicare Part B Does Not Cover

Medicare Part B does not cover long-term or custodial care, such as a stay in a nursing home. A stay in a skilled nursing facility, or SNF, that is needed after a hospital stay is often covered in Medicare Part A, so this type of treatment will not fall under Part B.

The plan also does not offer dental coverage or the cost of dentures, or routine examinations of the feet. Medicare Part B also does not cover the cost of eye exams that are needed only for getting eyeglasses, although it may pay for examinations related to diagnosing eye diseases and conditions.

Hearing aids are also not covered under Medicare, and this plan does not include cosmetic treatments and surgeries. Many alternative health care procedures, such as acupuncture, are also not covered under Medicare, although chiropractic care does typically fall under Part B.

Also, Medicare Part B does not cover any treatment that is covered under Medicare Part A and will not typically include the cost of routine prescriptions (note that prescription drug coverage is offered under Medicare Part D).

Medicare Part B Costs

Premium: Unlike Medicare Part A, there is a premium that is paid by everyone for Medicare Part B coverage. In 2018, the base rate for Medicare Part B is $134 for new enrollees; this amount may be higher for those in specific income brackets.

Deductible:  Medicare Part B also requires an annual deductible of $183 in 2018. This minor expense must be paid out-of-pocket before your Part B coverage takes effect.

Coinsurance:  Participants are also required to cover 20% of the remaining costs of their health care, without caps or limits. You would also be required to cover excessive costs that are not included in Medicare Part B; for example, private duty nursing or a home health aide that is not necessarily needed to treat your medical condition
Medicare FAQ
Medicare Supplemental Insurance Plans

Many supplemental insurance plans (also known as Medigap) cover treatments and costs that are not covered by Medicare Parts A or B and may be recommended for those with serious health concerns.

For example, the 20% of the costs not covered by Medicare Part B can be very costly for those undergoing chemotherapy. Enrolling in a Medigap plan can eliminate these extra costs.

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Who is Eligible for Medicare Part B?

If you are receiving Social Security benefits and are eligible for Medicare Part A, then you are automatically eligible for Part B.

For those who are not receiving Social Security benefits, you would be eligible for Medicare if you are 65 or older, a U.S. citizen, and lawfully residing in the United States for at least five years. Persons with end-stage renal disease or ALS may also be eligible for Medicare Parts A and B.

 Most people are automatically enrolled in Medicare Parts A and B when they begin receiving Social Security benefits. 

However, because there is a monthly premium for Medicare Part B, some people may decide to delay their enrollment in Part B coverage, primarily if they are still working and have health insurance coverage through their employer, or through a spouse's health insurance plan.

How to Enroll in Medicare Part B?

As said, most eligible participants are automatically enrolled in Medicare Parts A and B when they begin receiving Social Security benefits. You can decline enrollment in Part B when your card and related paperwork arrive in the mail and still enroll at a later date.

Note that delaying your enrollment in Medicare Part B can result in a penalty when you do decide to enroll. However, if you decline enrollment because you are covered under another health insurance plan, you have eight months from when that plan ends to enroll in Part B without paying a late fee or penalty.

You can enroll in Medicare Part B during the open enrollment period, January 1 through March 31, using the Social Security website, SSA.gov, or by calling the Social Security office, Monday through Friday, 7 a.m. to 7 p.m., at 1-800-772-1213. You can also visit a local Social Security office in person to enroll if there is one near you.

Still wondering about Medicare Part B?

 Get in touch and let us help you sort it all out, call 844-528-8688 or email us. If you’ll be enrolling soon, we can even help you choose the best Medigap plan to dodge all of those expensive out-of-pocket charges.

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