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MEDICARE PART B
Medicare Part B is a part of Original Medicare which provides coverage for inpatient and hospital care. It is otherwise known as medical Insurance and mostly covers medically-necessary services such as; doctor’s services and tests, preventive services, durable medical equipment and supplies, and other medical services.
Medicare Part B covers a wide range of services which, of course, are subject to certain coverage rules. For example, healthcare providers must accept Medicare assignment (a term of payment agreement with Medicare) and certain items and services must be medically necessary.
WHAT DOES MEDICARE PART B COVER?
Below is a list of basic medically-necessary services and items covered by Medicare Part B:
- Abdominal Aortic Aneurysm Screening
- Ambulance Services
- Bone Mass Measurement
- Cardiac Rehabilitation
- Cardiovascular Screenings
- Chiropractic Services
- Clinical Laboratory Services
- Clinical Research Studies
- Colorectal Cancer Screenings
- Defibrillator (Implantable Automatic)
- Diabetes Screenings
- Diabetes Self-Management Training
- Diabetes Supplies
- Doctor Services
- Durable Medical Equipment
- EKG Screening
- Emergency Department Services
- Eyeglasses (limited)
- Federally-Qualified Health Centre Services
- Flu Shots
- Foot Exams and Treatment (Diabetes-Related)
- Glaucoma Tests
- Hearing and Balance Exams
- Hepatitis B Shots
- HIV Screening
- Home Health Services
- Kidney Dialysis Services and Supplies
- Mammograms (Screening)
- Mental Health Care (outpatient)
- Non-doctor Services
- Occupational Therapy
- Other non-laboratory Tests
- Outpatient Medical and Surgical Services and Supplies
- Pap Tests and Pelvic Exams (includes clinical breast exam)
- Physical Exams
- Physical Therapy
- Pneumococcal Shot
- Prescription Drugs (Limited)
- Prostate Cancer Screenings
- Prosthetic or Orthotic Items
- Pulmonary Rehabilitation
- Rural Health Clinic Services
- Second Surgical Opinions
- Smoking Cessation (Counseling to quit Smoking)
- Speech-Language Pathology Services
- Surgical Dressing Services
- Transplants and other Immunosuppressive Drugs.
WHAT MEDICARE PART B DOES NOT COVER
- Medicare Part B does not cover the following:
- Long term care (i.e. Nursing homes)
- Most dental care (i.e. dentures)
- Eye exams for prescription glasses
- Cosmetic Surgery
- Hearing exams and hearing aids
- Routine foot care
- Health care outside of the U.S.
MEDICARE PART B ELIGIBILITY AND ENROLLMENT
Whoever is eligible for Premium-free Medicare Part A is also eligible for Part B simply by enrolling and paying a monthly premium. Those who are not eligible for premium-free Part A can qualify for Medicare Part B if they:
- Are 65 years or older
- Are Citizens of the United States or a permanent resident lawfully residing in the United States for at least 5 continuous years.
- Have any disability
However, those under 65 can qualify for Medicare Part B if they are receiving Social Security or Railroad Retirement Board (RRB) disability benefits. They’ll be automatically enrolled in Medicare Part A and Part B after 24 months of disability benefits.
Also, those with End-Stage-Renal-Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) who have not reached the age of 65 may be eligible.
WHEN CAN I ENROLL IN MEDICARE PART B?
Those receiving retirement benefits before age 65 or qualify for Medicare through disability are automatically enrolled in Medicare Part A and Part B as soon as they are eligible.
However, if you do not enroll during your initial enrolment period and do not qualify for a special enrollment period, you’ll have to sign up during the annual General Enrollment Period, which starts from January 1st and run through March 31st, with coverage starting July 1st. you may be required to pay a late enrollment penalty for failing to sign up when you were first eligible.
If you do not get enrolled automatically, you can apply for Medicare through Social Security, either at any Social Security office near you or through their official website at www.socialsecurity.gov
It is important to bear in mind that once you are both 65 years or older and have Medicare Part B, your six-month Medigap Open Enrollment begins.
This is the most appropriate time to get a Medicare Supplement Insurance plan because, during this period, beneficiaries are liable to get a “Guarantee-Issue Right” to purchase any Medigap plan without medical underwriting or paying a higher premium due to a pre-existing condition.
MEDICARE PART B PREMIUM COSTS
For some persons, they automatically get Medicare Part B while some need to sign up for it depending on if you get benefits from any of the following:
- Social Security.
- Office of Personnel Management
- Railroad Retirement Board
If you do not receive any of the above benefits, you’ll be charged for Part B services. Most beneficiaries will be required to pay the standard premium amount. For those whose Modified adjusted gross income is more than a certain amount, they’ll be required to pay an Income Related Monthly Adjustment Amount (IRMAA).
Medicare makes use of the modified adjusted gross income reported on a beneficiary’s IRS tax return from the past 2 years (which represents the most recent tax return information provided by the IRS).
Medicare Part B involves more cost and If you’re on a lower income scale, it may be too expensive for you.
The cost of Medicare Part B premium has been set by the Federal government at $144.60 for 2020. If your gross income is above $87,000 per annum, it may be higher.
Beneficiaries will be subject to an annual deductible of $198 for 2020 and will also be required to pay 20% of the bills for doctor visits and other outpatient services.
For beneficiaries who receive Social Security, the monthly premium will be deducted from their monthly benefit.
More so, for beneficiaries who do not have other insurance and didn’t sign up for Part B when they first enrolled in Medicare, they may likely be required to pay a higher monthly premium for as long as they’re in the program.
DIFFERENCE BETWEEN MEDICARE PART A AND MEDICARE PART B
While both Medicare Part A and Part B fall under the same healthcare plan, they both offer distinctively different services. However, it is wise to say one is meant to complement the other.
Medicare Part A is the hospital services part of Medicare which basically covers; inpatient care, hospital stays, skilled nursing facility care, hospice care, and medically needed home health care services.
On the other hand, Medicare Part B is the Medical services part of Medicare. It covers most of the Medically-necessary services not covered in Part A, such as outpatient and preventive services.
This covers items like; x-rays, bloodwork, doctor’s visits, and outpatient care. It also covers other medical items such as diabetic test strips, nebulizers, and wheelchairs.
MEDICARE PART B DRUG COVERAGE
Certain drugs are covered under Medicare Part D as part of a beneficiary’s inpatient care for some health conditions. This is different from Part D drug coverage which offers a wide range of Prescription coverage.
Part B drugs are usually administered by a healthcare provider (i.e. infusions, injections vaccines, and nebulizers) or through medical equipment at home. Drugs covered under Medicare Part B include but not limited to the following:
- Injections for osteoporosis
- Some transplant medications
- End-Stage-Renal-Disease (ESRD) Medications
- Flu, pneumonia, and Hepatitis B shots.
Medicare Part D may, however, cover medications that are not covered under Part B and vice versa. When you chose a Medicare plan be sure to check if it covers your current medications.