Part B – Medical Insurance
Medicare Part B covers a number of medically-necessary services and supplies.
Doctors’ Services – Anything that is medically necessary and does include outpatient and some doctor services that are received as if an inpatient or covered preventive services.
The costs are 20% of all individual procedures along with the Part B deductible
Outpatient Medical and Surgical Services and Supplies – For approved procedures like X-rays, a cast, or stitches the supplies are covered.
The costs are 20% of the Medicare-approved amount for the doctor’s services. There is also a co-pay for each service received in a hospital outpatient setting which can’t be more than the Part A hospital stay deductible. For any services that Medicare doesn’t cover they are the full responsibility of the beneficiary.
Home Health Care Services – Covers medically-necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, a continuing need for occupational therapy, home health aide services, medical social services, and medical supplies.
**Note; Must be verified by a doctor that home health services are needed due to the beneficiary being homebound.
The costs are nothing for covered home health services.
Durable Medical Equipment – Items such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by a doctor or other health care provider enrolled in Medicare for use in the home. Some items must be rented.
The costs are 20% of the Medicare-approved amount along with the Part B deductible.
** In order for Medicare to cover the equipment or supplies they MUST come from a Medicare approved supplier for Medicare to pay. **
Medicare Part B also covers preventive services like exams, lab tests, screening and shots to help prevent, find, or manage a medical problem. These preventive services are;
- “Welcome to Medicare” physical exam (one-time review of your health, education and counseling about the preventive services you need. To be covered must have the physical exam within the first 12 months you have Medicare Part B.)
- Physical Exam (yearly wellness exam beginning January 2011)
- Abdominal aortic aneurysm screening *
- Bone mass measurement
- Cardiovascular disease screenings
- Colorectal cancer screenings
- Diabetes screenings
- Flu Shots
What is NOT Covered by A & B
- Long Term Care
- Deductibles, coinsurance, or copayments when you get health care services.
- Dental care and dentures (in most cases).
- Cosmetic surgery.
- Custodial care (help with bathing, dressing, using the bathroom and eating) at home or in a nursing home.
- Health care you get while traveling outside of the United States (except in limited cases).
- Hearing aids and hearing exams.
- Orthopedic shoes.
- Outpatient prescription drugs (with only a few exceptions).
- Routine foot care (with only a few exceptions).
- Routine eye care and most eyeglasses (exception for one pair of standard frames after cataract surgery with an intraocular lens).
- Routine or yearly physical exams.
Medicare Part B Costs;
Premium for 2012
- $99.90 a month for individuals that earn $85,000 or less; for couples the amount is $170,000 or less.
Medicare Part B is now means tested – for those that earn too much income in retirement the premium will adjust as follows;
- Earn $85,001 – $107,000 – Premium = $139.90
- Earn $107,001 -$160,000 – Premium = $199.90
- Earn $160,001- $214,000 – Premium = $259.70
- Earn above – $214,000 – Premium = $319.70
**For couples please just double the income amounts**
Note; For those that pay for their Medicare premiums out of their Social Security amount – if there is no COLA adjustment from Social Security in a given year and the premiums are increased in that given year, they will not have to pay the higher amount. For those that pay separately will see the adjustment
Annual Deductible for 2012;
- $140 per year
The Co Pay for 2012;
- 20% per incident or where specified
The Initial Enrollment Period (IEP) is 3 months prior to your 65th birthday, the month of your 65th birthday and then the next 3 following months. During this time you will receive a Medicare Initial Enrollment Period
package when your IEP starts and it is suggested that you sign up in the 3 months leading to your 65th birthday so Part B benefits won’t be delayed.
This is where you will receive your red, white & blue Medicare card and if you have any issue just call Medicare at 800 – MEDICARE (800 – 633 – 4227)
If you are still working at age 65 you may want to enroll in Part A when you turn age 65, but wait to sign up for Part B since there are premiums (see Should You Choose Medicare Part B While Working). If there is an opportunity to fund an HSA please re-consider accepting Part A, once enrolled you can NOT fund one.
If you didn’t sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible because you’re covered under a group health plan based on current employment, you can sign up for Part A and/or Part B as follows:
Anytime that you or your spouse (or family member if you’re disabled) are working, and you’re covered by a group health plan through the employer or union based on that work
If not working or covered by a spouse then there will be a penalty which is;