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All One needs to Know about Medicare Part B

  • What is Medicare Part B?
  • How much does it cost to get Part B coverage?
  • What is covered under Part B plan?

To remove your confusion regarding Part B plans, allow yourself a couple of minutes to read this article.

Medicare part B provides coverage for services given by physicians and nurses, diagnostic and laboratory tests, X-rays, blood transfusion, outpatient hospital procedures, pneumonia and influenza vaccination, limited ambulance transportation, renal dialysis, immunosuppressive drugs and other outpatient treatment given in doctor’s offices. Medications given by the doctor to the patient during an office visit are also included in the doctor coverage.

Durable Medical Equipments or DME are also covered under the Part B plan. This equipment includes walkers, canes, wheelchairs, and mobility scooters. Prosthetic devices like breast prosthesis after mastectomy and artificial limbs, as well as oxygen for home use and pairs of eyeglasses are also covered.

Basically, products and services excluded from Part A are covered under Medicare Part B plans, including outpatient expenditures. If a person’s spouse is already working than Part B is optional and therefore can be deferred. The coverage starts as the patient meets his or her deductibles. The patient is required to pay just 20%, while the remaining 80% is taken care of by Medicare.

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Eligibility and Enrollment Procedure
The only criterion to be eligible for Part B is to be a US citizen or residing in the country for at least five consecutive years. The applicant is not required to be enrolled in Part A to be eligible for Part B. People who are receiving railroad retirement, social security or federal retirement benefit as they turn 65 are automatically enrolled in Medicare Part B.

As a person is two to three months short of turning 65, he or she is sent a package containing their membership card and information booklet. The premium is deducted from the social security or government benefit on its own. In case the person does not want to get enrolled in Part B, they can send a filled in form given in the package.

On the other hand, if a person is not enrolled automatically in Part B, than it can be done around three months prior to 65th birthday. The coverage will however start when they turn 65. For enrollment the person can contact any of the social security office.

How much does Part B cost?
Every person pays a monthly premium for Medicare Part B plan. The value of premium goes up on every January 1. $94 is the basic premium which most people pay each month. The premium depends on the annual income of a person. Premium for a single person with an annual gross income of $82,000 is higher in comparison to married couples whose combined annual income exceeds $164,000.

  • Annual income of $102,000/$204,000 (single/couple) attracts a monthly premium of $122.20 per head.
  • Above that amount and up to $153,000/$306,000 (single/couple) each person pays monthly premium of $160.90.
  • Above that amount and up to $205,000/$410,000 (single/couple) each person shell out $199.70 as monthly premium.
  • Above $205,000/$410,000 the monthly premium reaches $238.40 per head.

The premium amount is based on the tax returns of the past two years. People whose income levels have dropped considerably can contact the Medicare and request for premium adjustment. People, although eligible, for some reason were not able to enroll in the plan will be required to pay ten percent higher premium each year due to delay in Medicare enrollment.

What is not included in Part B coverage?
Although Part B covers almost the whole of outpatient care, however, there are few exceptions which are as follows:

  • Routine medical examination, after the initial medical exam.
  • Immunizations or vaccinations other than flu shots and pneumonia.
  • Acupressure, acupuncture and homeopathy.
  • Elective or cosmetic surgery.
  • Routine ear or eye examination, hearing aids, contact lenses or eye glasses change.
  • Dental work
  • Prescription taken at home

How much does Medicare Part B cover?
Medicare pays all or a portion, known as the approved charge, of the entire expenditure for each covered item. The percentage covered depends on the type of service the beneficiary is enrolled in.

  • Doctor coverage: 80% of expenditure
  • Home healthcare: 80% on medical equipment; and 100% agency charge
  • Laboratory costs: 100% of X-ray, laboratory and diagnostic charges
  • Ambulance: 80%
  • 50% of outpatient mental healthcare
  • 100% of pneumonia and flu vaccination
  • Outpatient therapy: 100% of Medicare approved home Medicare health care; 100% of hospital OPD; 80% of treatment at therapist or doctor’s office

Where can one find more information?
Medicare’s website contains all the information regarding eligibility, enrollment and doctor coverage for Medicare Part B. Information can also be had by calling in at the toll free number (800) – MEDICARE. The daily operations for Part B are handled by large privately run insurance firms known as Medicare “carriers”.

Any person is free to contact any of these carriers if they have any complaints or questions regarding doctor coverage. The name and the contact information of the concerned carrier are given on the upper right corner of Medicare Summary Notice. This information can also be had from the website of Medicare.

Understanding Medicare Bureaucracy can be a daunting task, but the benefits are equally sweet as a person learns to navigate through them.

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