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Medicare Part B Medical Insurance

Generally called medical insurance, Part B covers other medical care. Physician care--whether it was received while you were an inpatient at a hospital, at a doctor's office, or as an outpatient at a hospital or other health-care facility--is covered under Part B.

In addition, ambulance service, laboratory tests, and physical therapy or rehabilitation services are covered. Part B also covers 100 percent of the cost of many preventive services and an annual wellness visit.

Medicare Part B Medical Insurance 

What is it?

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.

What is the cost to enrollees?

Premiums

In 2015, the Medicare Part B premium for most people is $104.90. Your monthly premium will be higher if you file an individual income tax return and your modified adjusted gross income (MAGI) is more than $85,000, or if you file a joint income tax return and your MAGI is more than $170,000. These income thresholds will remain the same through 2019.

Deductibles

The Medicare Part B deductible is $147 in 2015.

What does Medicare Part B cover?

Medical care that is not inpatient is usually covered under Medicare Part B. Medicare Part B covers 80 percent of medically necessary physician or outpatient charges, including charges from a physician for care received in a hospital. The Part B deductible generally applies.

Services covered under Medicare Part B

Currently, services covered under Medicare Part B (the 20 percent coinsurance charge and deductible generally apply) include:

  • Physician and surgeon fees
  • Outpatient services
  • Immunosuppressive drugs
  • Blood service, after you pay for the first three pints of blood in any calendar year
  • Clinical laboratory services
  • Some coverage for outpatient mental health visits
  • Certain medically-necessary home health services
  • Physical and occupational therapy
  • Ambulance service

Medicare also fully covers the cost of most preventive services (beneficiaries will pay nothing out-of-pocket) if a health-care provider accepts Medicare assignments. Some services are limited to one per year. The preventive services Medicare fully covers include:

  • An annual wellness exam to develop or update a personalized prevention plan
  • Annual mammograms for individuals age 40 or older, and a baseline mammogram for individuals between ages 35 and 39
  • Pap test and pelvic exams
  • Pneumococcal and flu vaccines
  • Hepatitis B vaccines for high-risk individuals
  • HIV screening test
  • Colorectal cancer screening test
  • Diabetes screening test
  • Cardiovascular screening test
  • Bone density measurements for women at risk for osteoporosis
  • Self-management training for individuals with diabetes
  • Medical nutrition therapy for individuals with diabetes or kidney disease
  • Smoking cessation counseling if you haven't yet been diagnosed with a tobacco-related illness
  • Depression screening (test is fully covered; you generally have to pay 20 percent for doctor's visit)
  • Alcohol misuse screening and counseling
  • Obesity screening and counseling

Services excluded from Medicare Part B coverage

In general, Medicare pays only for services it considers reasonable or medically necessary. Specific exclusions include:

  • Cosmetic surgery, unless particular medical conditions render it necessary
  • Procedures considered experimental
  • Hearing aids and fittings
  • Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine
  • Most eyeglasses and eye exams
  • Most dentures and dental care
  • Prescription drugs you administer yourself, such as those you buy at a drug store and take at home (exceptions are immunosuppressive drugs and antirejection drugs for kidney transplant patients)
  • Over-the-counter drugs
  • Care outside of the United States (except when a Mexican or Canadian hospital is closer, such as in an emergency, even though you reside in the United States, or if you require care while traveling through Canada en route to Alaska)

Prescription drug coverage is available under Medicare Part D (prescription drug coverage).

Medicare regulations specifying what it will cover almost always begin with a general rule, followed by exceptions. If you are denied coverage, it is always wise to look into whether or not you can meet one of the exceptions.

You can get further information about coverage under Medicare Part B by calling the Social Security Administration at (800) 772-1213 or by visiting www.ssa.gov (the Social Security Administration website) or www.medicare.gov. The Medicare website contains a comprehensive list of covered services, including a preventive care checklist that you can take to your health-care provider to find out which services are right for you.

 

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