November 22, 2011
Medicare Part B - Medicare Medical Coverage
What is Medicare Part B?
Part B is the category of Medicare medical insurance coverage that pertains to various outpatient medical services and other doctor services. Part B is a voluntary program and Medicare-eligible individuals must enroll in Medicare Part B in order to receive the program's benefits.
Medicare Part B covered services are reimbursed at 80% of the "reasonable charge" for the service. The person receiving the service is responsible for paying the remaining 20%. However, this reasonable charge is determined by Medicare and may not adequately reflect the costs you pay to your physician. When a doctor agrees to accept the Medicare set "reasonable charge" as full payment, he or she is said to accept "assignment." When a doctor does not accept "assignment" the patient is responsible for paying the outstanding balance minus the Medicare-determined reimbursement. However, federal law sets a limit as to the maximum amount a doctor may bill for a service. The maximum amount to be billed for a Medicare Part B covered service is 115% of the Medicare "reasonable charge." If the doctor bills above this cap, he or she violates federal law.
What does Medicare Part B Cover?
The Medicare medical coverage provided by Part B is expansive. Some of the important medical services covered are:
- Diagnostic tests/lab work/screenings
- Doctor services
- Nursing services
- Chemotherapy
- Certain diabetic supplies
- Flu and pneumonia vaccinations
- Durable medical equipment
- Some mammography and pap smear screening
Medicare Part B does not cover various items including:
- Prescription drugs (that are not administered to you by a physician)
- Routine physical check-ups
- Eye examinations and eye glasses
- Hearing aids
Medicare Part B Premiums for 2012
The monthly premium for Medicare Part B can change annually. It is common for enrollees to have their Part B premium deducted from their Social Security check.
In 2012, most people will continue to pay $115.40 for their monthly Medicare Part B premium. However, some people are required to pay higher premiums. For example, people who enrolled in Part B for the first time on January 1, 2012 or later will pay $99.90. Additionally, individuals with income above $85,000 and couples with income above $170,000 will pay even higher premiums.
