Medicare B: What You Should Know In Order To Maximize Your Benefits


Medicare Part B

Medicare Part B (Medical Insurance) helps cover your doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium.

Medicare Part B Helps Cover Your:

  • Medical and Other Services: Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.
  • Clinical Laboratory Services: Blood tests, urinalysis, and more.
  • Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and 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 get as an outpatient or as part of a Part B covered service.

So you may be wondering what is excluded from coverage?

The Original Medicare Plan does not cover everything.  Health care costs not covered by Medicare will include, but are not limited to:

  • Acupuncture.
  • 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 (see exception above for one pair of standard frames after cataract surgery with an introcular lens).
  • Routine or yearly physical exams.
  • Certain screening tests
  • Certain shots (vaccinations)

Who is entitled to coverage?

Most people sign up for and buy Medicare Part B. If you want to join a Medicare managed care plan or a Medicare Private Fee-for-Service plan, you will need to have both Medicare Parts A and B.

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance).

Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Part B:  Premium

The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40.  However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.

In 2012, Social Security monthly payments to enrollees will increase by 3.6 percent.    The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.

As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income.  Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.

In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount.  These income-related amounts were phased-in over three years, beginning in 2007.  About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.

Medicare Deductible and Coinsurance Amounts for 2012: 

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

  • $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.

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