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Medicare Part B - Medicare Medical Coverage

What is Medicare Part B?

Medicare Part B is the category of Medicare medical insurance coverage that includes various outpatient medical services, doctor services, other home health services. Part B is a voluntary program and Medicare-eligible individuals must enroll to receive the program's benefits. To be eligible for Medicare Part B, one must be a U.S. citizen over the age of 65 or younger with a qualifying disability. Most beneficiaries are automatically enrolled in Part B and will receive their Medicare card in the mail three months before their 65th birthday. Those who are not automatically enrolled must fill out an application for Part B coverage.

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:

  • "Welcome to Medicare" physical exam and yearly wellness exams
  • Diagnostic tests/lab work/screenings
  • Doctor services
  • Ambulance services
  • Nursing services
  • Chemotherapy
  • Certain diabetic supplies
  • Flu and pneumonia vaccinations
  • Durable medical equipment (e.g. wheelchairs, walkers, etc.)
  • 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 aside from yearly wellness exams
  • Alternative care such as chiropractic
  • Vaccinations or immunizations other than the flu and pneumonia shots
  • Eye examinations and eye glasses
  • Hearing aids

Medicare Part B Costs

The monthly premium for Medicare Part B can change annually and it is common for enrollees to have their Part B premium deducted from their Social Security check.

In 2014, most people will continue to pay $104.90 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, 2014 or later will pay $104.90. Additionally, individuals with income above $85,000 and couples with income above $170,000 will pay even higher premiums.

Additionally, beneficiaries must pay a yearly deductible before Medicare begins paying its share. In 2014, this deductible is $147. Once this is covered, beneficiaries only pay 20% of the Medicare-approved amount ("reasonable charge") while Medicare covers the remaining 80%.



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Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.

 
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