There is a way out for our senior citizens and disabled people to cover healthcare costs and save money on outpatient expenses and medical equipment.
Medicare Part B is one of the four parts of the Medicare Plan and it covers outpatient care such as doctor visits, preventive services, lab tests; durable medical equipment, and mental health services.
What is Medicare Part B and How Does It Work?
Medicare Part B is one of the four parts of the Medicare Plan and it covers outpatient care such as doctor visits, preventive services, lab tests, and mental health services.
Part B Medicare also covers durable medical equipment such as wheelchairs and oxygen tanks, Home health care, ambulance services, and most professionally administered prescription drugs.
What are the Differences Between Medicare Part A and Medicare Part B?
Medicare Part A covers in-patient hospital services such as skilled nursing facilities whereas Medicare Part B covers outpatient care like doctor visits.
What Services Does Medicare Part B Cover?
Medical and healthcare services covered by Medicare Part B are:
- Outpatient care such as doctor visits
- Preventive services
- Lab tests
- Mental health services
- Durable medical equipment such as wheelchairs and oxygen tanks
- Home health care
- Ambulance services
- Professionally administered prescription drugs
What are Some Preventive Services Covered by Medicare Part B?
Preventive care is the service that helps detect and prevent diseases at an early stage. Some preventive services covered by Medicare Part B are:
- Abdominal aortic aneurysm screening
- Alcohol misuse screening and counseling
- Bone mass measurement
- Cardiovascular disease screening
- Cervical and vaginal cancer screening
- Colorectal cancer screening
How Does Medicare Part B Cover Outpatient Care, Home Health Care, and Durable Medical Equipment?
Medicare Part B covers medically necessary services such as doctor visits, durable medical equipment, preventive screening services, etc. Medicare pays for most of these services except expenses like deductibles, coinsurance, or copayments. Medicare typically covers 80% of the RUC-set rate for approved services, while the rest of the payments need to be made by you or your supplement health insurance plan like Medigap.
Who is Eligible for Medicare Part B and How Do I Enroll?
Beneficiaries eligible for premium-free Medicare Part A are also eligible to enroll in Medicare Part B. Premium-free Medicare means you or your spouse must have paid Medicare taxes for at least 10 years.
To enroll in medicare part B, you need to:
- Be age 65 years or older
- Be a U.S. resident or U.S. citizen
- Be an individual with permanent residence who has been living in the U.S. for more than 5 years
What are the Medicare Eligibility Requirements for Part B?
To be able to enroll in medicare part B, you need to fulfill the following requirements:
- Be age 65 years or older
- You or your spouse must have paid Medicare taxes for at least 10 years
- You are a U.S. resident
- You are under 65 and have a disability that qualifies you for Social Security Disability Insurance (SSDI) for at least 24 months
- You have end-stage renal disease (ESRD) (No age limit criteria for this condition)
- You have amyotrophic lateral sclerosis (ALS) aka Lou Gehrig’s disease (No age limit criteria for this condition)
How Can I Enroll in Medicare Part B and What are the Enrollment Periods?
To enroll in medicare part B, you need to first check your age eligibility i.e. 65 years or older, and other eligibilities listed above.
There are three enrollment periods in which you can apply for Medicare Part B:
- Initial enrollment period: This is a 7-month enrollment period that starts from 3 months before your 65th birthday and ends 3 months after that month.
- General enrollment period: This is an annual enrollment period starting on 1st January and ending on 31st March.
- Special enrollment period: This is when you lose your employer-based health coverage and it ends eight months later.
How Much Does Medicare Part B Cost and What are the Copays and Deductibles?
Medicare Part B typically costs $164.90 each month or higher depending on your income. SSA decides your premium fees based on your income.
Under Medicare Part B, You have to pay a deductible of $226 each year before the Original Medicare starts to pay for you. After this, you’ll pay a 20% copay for most in-patient doctor services, DME, and outpatient therapy.
What are the Costs of Medicare Part B Premiums, Copays, and Deductibles?
The costs of Medicare Part B are as follows:
Premiums: $164.90 each month or higher depending on your income.
Deductibles: $226 annually before the Original Medicare starts to pay for you.
Copays: 20% of the doctor services while hospitalized, including DME and outpatient therapy.
What are the Advantages and Disadvantages of Medicare Part B?
Advantages of Medicare Part B are:
- It covers outpatient care such as doctor visits and preventive screening services
- It covers durable medical equipment such as wheelchairs, canes, blood sugar monitors, etc
- It has a reasonable monthly cost of $165.90
- You get to choose any healthcare provider who accepts Medicare
Disadvantages of Medicare Part B are:
- It has an annual deductible of $226
- After meeting the deductible, you need to pay 20% coinsurance or copays for most covered services
- Part B does not cover medical or health conditions such as dental, vision, or hearing care. It also does not provide prescription drugs, routine foot care, or custodial care.
How Can I Avoid Medicare Fraud and Scams?
You can avoid Medicare Fraud or Scams by
- Protect your Medicare card like a credit card. Don’t give it to anyone and avoid losing it.
- Never give your Medicare number to any stranger in person or on the phone except your healthcare provider or authorized agent.
- Do not fall for scammy Medicare plans. Always verify the Medicare healthcare provider’s and its company’s background. You can do so at medicare.gov
- Do not provide your Medicare information in return for “free” healthcare services.
- Do not fall for door-to-door Medicare salespeople. Neither Medicare nor insurance companies in contract with them will come to your house and sell you any Medicare “Scheme”.
- Go thoroughly through your Medicare statements. Make sure that you have received every service and facility that you have paid for or have been insured for.
How Can I Report Medicare Fraud and Scams?
If you suspect any medicare scam or fraud, you can take the following actions:
- You can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048
- You can reach out to the Department of Health and Human Services (HHS) Office of Inspector General (OIG) at 1-800-HHS-TIPS (1-800-447-8477) or TTY 1-800-377-4950.
- You can complain online with the OIG. Register at https://oig.hhs.gov/fraud/report-fraud/
- You can contact the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-722-3379).
