Medicare Part B – In Detail

What does Medicare Part B cover?

Medical and other services

  • Doctors’ services, except for routine physical exams
  • A “Welcome to Medicare” one-time physical exam within the first six months of enrollment into Part B
  • Outpatient medical and surgical services and supplies
  • Ambulatory surgery center facility fees for approved procedures
  • Durable medical equipment, including wheelchairs, hospital beds, oxygen, and walkers
  • A second – and sometimes a third – surgical opinion for non-emergency surgery that isn’t an emergency (in some cases)
  • Outpatient mental healthcare
  • Outpatient occupational and physical therapy, including speech-language pathology
  • Preventative Services, including healthcare to prevent illness (such as the flu) or detect it at an early stage (such as blood tests, Urinalysis, Mammograms)

Clinical laboratory services

  • Blood tests
  • Urinalysis
  • Some screening tests and more

Home healthcare

    • Reasonable and necessary part-time or intermittent skilled nursing care and home health aide services

 

  • Physical therapy, occupational therapy, and speech-language pathology ordered by your doctor and provided by a Medicare-certified home health agency
  • When skilled nursing care or therapy services are being provided, home health aide services may also be covered if needed
  • Medical social services
  • Durable medical equipment, including wheelchairs, hospital beds, oxygen, and walkers
  • Medical supplies and other services

Outpatient hospital services

Hospital services and supplies received as an outpatient as part of a doctor’s care.

Blood

Pints of blood you receive as an outpatient or as part of a Part B-covered service.

Part B Strengths:

  • Affordable
  • Most people pay a monthly premium in 2017 of $134.00
  • This can be higher for high-income beneficiaries!
  • $183 Annual Deductible (2017), then 80% coinsurance.
  • Client can go to any qualified doctor in the United States that accepts New Medicare Patients.
  • Enrollment is easy. You cannot be turned down because of medical history or pre-existing illness

Part B Weaknesses:

  • If you delay enrollment, or a high income earner, you may have to pay a higher premium (late enrollment penalty, IRMAA Penalty)
  • Preventive care is somewhat limited, although improving.
  • For your 20% coinsurance responsibility, there is no maximum out of pocket
  • 20% of infinity is LIFE CHANGING
  • Coverage stops at the border
  • No coverage outside of the U.S.

NO COST, NO OBLIGATION

Answers To Your Medicare Questions



What Services Are NOT Covered By Medicare Part A & Part B ?

 Medicare doesn’t cover everything.

If you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless one of the following applies to you:

  • You have other insurance (including Medicaid) to cover the costs.
  • You’re in a Medicare health plan that covers these services.
  • Even if Medicare covers a service or item, you will generally have to pay deductibles, coinsurance, and copayments.

Some of the items and services that Medicare Part A and Part B doesn’t cover include the following:

  • Long-term care (also called custodial care)
  • Routine dental care. Dentures.
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids. Exams for fitting hearing aids.
  • Final Expenses
  • Non-Medical Expenses Related To Care

Let us help you navigate the confusion