When you turn 65, you become eligible to receive Medicare insurance benefits. Original Medicare offers Part A and Part B. These benefits are offered to all Medicare recipients. When signing up for Medicare, it is critical to know what coverage you can expect and what options you may have.
What is Medicare Part B and What Does it Cover?
Medicare Part A and Part B are designed to cover inpatient and outpatient expenses. Part A is designed specifically for inpatient stays in hospitals, skilled nursing facilities, and hospice care. Part B, on the other hand, provides coverage at outpatient facilities and doctor offices and is designed to cover medically necessary services and preventive services.
Medically necessary services are those that are required to diagnose or treat a specific illness, injury, or condition. These services must also meet the accepted standards of medical practice. These services may include imaging, such as an x-ray, MRI, or CT scan, that may be needed to evaluate an injury or to examine your body for additional damage following an accident.
Injections, physical therapy, or other modalities are also often covered under Part B as they are used to treat a condition. Durable medical equipment required after an injury, procedure, or diagnosis is also covered. Medically necessary services may also include clinical research studies, such as sleep studies, to evaluate your breathing patterns or to diagnose a condition, such as sleep apnea. Ambulance rides also fall under the category of medically necessary services covered by Part B.
Preventive services are those that are used to help prevent an illness from occurring altogether or to detect it in its early stages to prevent it from worsening. Examples of these services may include annual wellness visits to your primary care physician to establish your general health and identify any potential issues. Preventive services may also include vaccines or certain medications that are used to prevent specific diseases, such as the flu, shingles, tetanus, measles, mumps, rubella, and more.
What Services are Not Covered by Part B?
While it is good to know what services are covered under Part B, it is also good to be aware of those that are not. Part B does not provide any coverage related to vision, dental, or hearing care. This means that you will not receive any reimbursement for routine dental checkups, fillings, or dentures; routine vision care, including eye exams, glasses, or contacts; or hearing appointments and hearing aids.
Part B also does not cover elective procedures, massage therapy, acupuncture, or cosmetic surgery, as these procedures are often not deemed to be medically necessary by the insurance company.
How Much Does Part B Cost?
Part B medical insurance is associated with monthly premium payments, an annual deductible, and coinsurance payments for services. In 2020, the base monthly premium payment is $144.60. This amount applies to anyone making less than $87,000 annually as an individual or $174,000 for those filing jointly. If you exceed these numbers, your premium payment will be slightly higher.
In addition to the premium payments, Medicare Part B also requires an annual deductible to be met. In 2020, the deductible is set to $198. You will need to pay this amount completely out of pocket before Medicare will begin covering your services.
Once you have met your deductible, you will then pay a coinsurance of 20 percent of the Medicare-approved amount. This amount is pre-set by Medicare and sets a limit as to the maximum amount they will pay for a service. Some physicians and facilities accept assignment, meaning they agree to charge only the approved amount, with you only being responsible for 20 percent of it.
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