Having access to a physician who can address your concerns, diagnosis medical issues, and treat you is absolutely essential, especially as we age. When you first become eligible for Medicare when you turn 65, you have the option of enrolling in Medicare Part B (Medical Insurance.) Most people choose to enroll in Part B as soon as they are eligible to avoid late enrollment penalties when they join after their initial enrollment period has ended, but enrolling in Part B isn’t just a financial decision. Part B coverage can make a big difference in your overall health, now and in the future.
Seeing a Physician – Medicare Part B Benefits
Medicare Part B helps cover the cost of medically necessary services and supplies that meet accepted standards of medical practice in a physician’s office or outpatient setting in order to diagnose and treat a medical condition. Part B includes coverage for ambulance services, clinical research, inpatient and outpatient mental health care, a second opinion before surgery, and durable medical equipment (DME). DME includes medically necessary equipment you need to use in your home and that is prescribed by a physician.
Part B also covers a wide range of preventive services, including a Welcome to Medicare visit when you are first enrolled, and annual Wellness visits after you have had Part B for 12 months. These annual exams can serve as great opportunities to build a rapport with your doctor, discuss your family medical history, and keep track of any changes in your physical or mental health.
Do You Have to See Specific Doctors?
When you become eligible for Medicare, you have the choice to get your Part A and/or Part B benefits through Original Medicare, the federal program that administers your coverage, or through a Medicare Advantage plan, offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits. If you have Original Medicare Part B, you may visit any doctor who is participating in Medicare and accepts assignment. You do not need referrals from a primary doctor in order to see a specialist. You can visit any specialist that accepts assignment, as well. You will likely pay 20% of the Medicare approved amount and the Part B deductible may apply.
If you choose to enroll in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans provide additional coverage, including prescription drug coverage, vision and dental care, and annual out-of-pocket maximums. If you are enrolled in a Medicare Advantage plan, you will likely have to visit doctors and specialists that belong to your plan’s network. If you go outside of the plan’s network, you may be responsible for the full amount of any medical care you receive.
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