Medicare Part B Coverage

Medicare Part B explained! Discover how benefits, coverage & pricing work in our helpful, 2019 Medicare Part B Guide.

Medicare Part B Explained

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Medicare Part B Explained
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Medicare Part B 2019 Chart
Medicare Part B covers;
Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health
Limited outpatient prescription drugs
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Maybe you’ve heard some information about Medicare Part B from friends & family but what exactly is Medicare Part B anyway? How does Part B work with Medicare Insurance benefits? We consolidated all the information and simplified the important details by answering common questions (See FAQ’s above) to help save you time, money & energy!

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Last Updated: 10/2/2019

What is Medicare Part B?

Medicare Part B is Supplemental Medical Insurance (SMI) that is provided by the U.S. Government to cover medically necessary & preventive services. Medicare Part B works in conjunction with Medicare Part A (called Original Medicare) and covers approximately 80% of all standard senior health care costs. Most everyone pays a premium for Part B unless covered by certain Medigap Plans (Note: Plan C & Plan F & High Deductible Plan F are no longer available to new Medicare enrollees after Jan 1, 2020!).

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What does Medicare Part B cover?

Part B covers two (2) types of services plus the following coverage;

  1. Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  2. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment (the approved amount by Medicare and shouldn’t cost you more!).

Coverage includes;

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

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Am I eligible for Medicare Part B?

Those who have received all their Social Security credits are usually, automatically eligible & enrolled into premium-free, Medicare Part A and are thus eligible to enroll in Medicare Part B (usually during the Initial Enrollment Period (IEP) or Special Enrollment Period (SEP) without stipulation. For those who have not received full social security credit, one must first be enrolled in Medicare Part A by paying the premiums and pass the eligibility requirements set forth by Medicare which are;

  • You must be 64 years & 9 months or older.
  • Be a U.S. resident; AND
  • Be either a U.S. citizen, OR
  • Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

When and if these eligibility requirements are met, one can enroll in Medicare Part B.

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How to enroll in Medicare Part B?

In most cases enrollment in Medicare Part B will be provided automatically the first day of the month one turns 65. Unless, your birthday is on the first day of the month by which Part A and B will start the first day of the prior month. Some decide to hold-off paying for Medicare Part B even after enrolling in Medicare Part A but please be aware that you may incur a LIFETIME ENROLLMENT PENALTY. Basically, if you forget or choose to delay your Part B enrollment you will be permanently penalized for as long as you have Part B. Your fee may go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t sign up for it! Plus, you may also have to wait for the General Enrollment Period (Jan 1 – Mar 31) to enroll in Part B and then your coverage will begin July 1 of that year. We suggest you get Part A & Part B when you are first eligible. If you are still under an employer “group” health insurance, you should speak to both your the company’s Plan Manager and the health plan provider to ensure they are giving you sound advice!

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What does Medicare Part B cost for 2019?

The 2019 Standard Premium Amount & Annual Deductible for Medicare Part B is;

  • $135.50 / Per Month
  • Annual Deductible = $185.00 / Per Year

After this deductible is met, 80% of the Medicare-approved amounts are covered. Unlike Medicare Part A, Medicare Part B does not offer a premium-free benefit regardless of how many Social Security credits one has earned. As such, everyone pays a premium for this coverage called the Part B Standard Monthly Premium for as long as one has Part B (even if unused). If your Modified Adjusted Gross Income is beyond a “certain limit”, you will pay Income Related Monthly Adjustment Amount (IRMAA) which is determined by your last two years tax returns and is normally an increased rate. See the Medicare Part B cost table.

In addition to the premium payment every month, Medicare Part B also carries with it an annual deductible after which covers 80% of Part B claims and no annual out-of-pocket maximum. The remaining 20% is also required to be paid by the enrollee which constitutes coinsurance. This coinsurance and additional costs can be supplemented with a Medicare Supplement Insurance Policy, also called a Medigap Plan because it covers the 20% cost “gap” associated with Original Medicare (Parts A & B).

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How do I pay for Medicare Part B?

Medicare Part B is deducted from your Social Security benefit payment or Railroad Retirement Board (RRB) benefits. Civil Service retirees that are NOT entitled to Social Security, premiums are deducted from your Civil Service annuity.

You can pay for Medicare via direct bank deposit, Medicare Easy Pay, check, money order, mail-in or online credit & debit. You need to pay attention to what “bill type” you get. See the “bill type” checklist.

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What does Medicare Part B not cover in 2019

Medicare Part B does not cover the following items in 2019;

  • Deductibles
  • Coinsurances
  • Co-payments
  • Long-term care (also called custodial care)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

To find out if a test, product or service is not covered by Medicare Part B, we recommend using the Medicare.Gov “Coverage Search Tool” for exact information.

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How does Medicare Part B work with Medicare Part D prescription drug coverage?

Although Part D drug plans are compatible with Medicare Part B, they are separate insurance policies. Enrollees will need to purchase a drug plan from one of multiple providers. Most enrollees have a guaranteed eligibility for a Part D plan when they enroll in Plan D (on-time). It is best to avoid the Part D Enrollment Penalty by enrolling during your initial enrollment period (also known as, IEP). Did you know that drugs administered in a Hospital setting are generally covered under your Medicare Part A? For more information on enrollments, visit the Medicare Enrollment Periods page. If you choose to keep Orginal Medicare and need a drug plan, you can also bundle a Medigap Plan with it. We at Bridge, can help you.

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How does Medicare Part B work with Medigap Plans?

Medicare Part B is compatible with Medigap Plans however, since they are considered standalone plans, Medigap Policies need to be purchased separately. By working with a Bridge Agent, we can help you find an affordable Medigap plan to fit your needs.

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How does Medicare Part B work with Medicare Advantage Plans?

Unfortunately, Medicare Advantage Plans (Part C) do not work with Medicare Part B since they are on separate programs. Those enrolling in Medicare Advantage dis-enroll from Original Medicare (Part A & B) and should consider the pros and cons before making that decision.

Although, Medicare Advantage Plans are appealing based on price & perks, they can also come with a few Medicare pitfalls that may have you reconsider the real “advantage”. For example;

  1. Prices have been historically unstable.
  2. Your coverage will change annually.
  3. You could be locked-in without the future option for a Medigap Plan
  4. You’re responsible for out-of-network, Physician costs.
  5. No coverage beyond your service area.
  6. Must use in-network providers.
  7. No travel coverage.
  8. May need a referral to see a specialist.

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Additionally, If you have a MA plan & diagnosed with a critical illness such as cancer, heart attack or stroke, costs for treatment if the hospital is out-of-network may not be covered in your plan. The max out-of-pocket only applies to covered services and could require a specialist referral. People with MA plans, think they have more coverage than they actually do unlike Medigap plans, which is considered more comprehensive senior health coverage plan. For more information on Medicare choices, check out these articles on Medigap vs. Medicare Advantage or Original Medicare vs. Medicare Advantage.

How does Medicare Part B work with Dental, Vision & Hearing Insurance (DVH)?

Part B works with DVH plans however, since they are considered standalone plans, DVH’s would need to be purchased separately. By working with a Bridge Agent, we can help you find an affordable DVH insurance plan to fit your needs.

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How does Medicare Part B work with a Critical Illness Insurance for cancer, heart-attack & stroke coverage (CHAS)?

Medicare Part B is compatible with CHAS insurance / cancer plans however, since they are considered standalone plans, they would need to be purchased separately. By working with a Bridge Agent, we can help you find an CHAS and/or affordable critical illness insurance plans to fit your needs.

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How does Medicare Part B work with a Long Term Care Insurance (LTC)?

LTC plans are compatible with Medicare Part B however, since they are considered standalone plans, they would need to be purchased separately. There is talk about developing a new Medigap plan to include LTC coverage. By working with a Bridge Agent, we can help you find an affordable LTC insurance plan to fit your needs(LTC).

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How does Medicare Part B work with a Health Savings Account (HSA)?

Medicare Part B is considered a qualified expense to pay out of your Health Savings Account (HSA). A HSA can pay for Medicare Parts A, B, C & D. Once enrolled in Medicare, enrollees are no longer able to contribute to their Health Savings Account. However, the funds can be used to pay for qualified Medicare costs stated above. If one postpones Medicare enrollment they may still contribute to their Health Savings but enrolling late will also be subject to a Medicare Late Enrollment Penalty which is a percentage increase of costs per year. Speak with your Financial Advisor to determine what works best for you!

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2019 Medigap Guide

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“I’m gonna keep Social Security without change, except I’m going to get rid of the waste, fraud, and abuse; same thing with Medicare.” –
Donald Trump

Let’s revisit Medicare Part B List of Coverage and expound on each these coverages in a bit more detail. Due to the complexity and changing nature of health services, politics and coverages, we will do our best to provide concise information. Feel free to refer back to our sources for more information or Medicare.gov.

In General, Part B coverages include;

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

You will be responsible for 20% of the costs.

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What does Medicare Part B cover for Clinical Research?

Clinical research are studies done by medical professionals who test how well new treatments work and their safety. Medicare Part A & B cover some of the costs for;

  • Office visits
  • Tests

*In certain qualifying clinical research studies. See if you should join a clinical research study

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What does Medicare Part B cover for Ambulance services?

Part B may cover ground ambulance transportation services (in case of emergency: airplane/helicopter) to the nearest;

  • Hospital
  • Critical Access Hospital
  • Skilled Nursing Facility

If transportation is considered “scheduled”, it is not covered. In order to be eligible for coverage of non-emergency ambulance services, you would need to be; 1. confined to your bed (unable to get up, walk, or sit in a wheelchair without help. Or 2: need vital medical services during your trip that are exclusively available in an ambulance.

You will be responsible for 20% of the costs.

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What does Medicare Part B cover for Durable Medical Equipment (DME)?

Durable Medical Equipment (DME) is Physician prescribed equipment that can with stand repeated use within your home that would not be useful to anyone unless they were sick. The following DME coverage list is covered under Medicare Part B (but not limited to);

  • Blood sugar monitors
  • Blood sugar test strips
  • Canes
  • Commode chairs
  • Continuous passive motion devices
  • Continuous Positive Airway Pressure (CPAP) devices
  • Crutches
  • Hospital beds (possibly rented)
  • Infusion pumps & supplies
  • Lancet devices & lancets
  • Nebulizers & nebulizer medications
  • Oxygen equipment & accessories
  • Patient lifts
  • Pressure-reducing beds, mattresses, and mattress overlays
  • Suction pumps
  • Traction equipment
  • Walkers
  • Wheelchairs & scooters

You will be responsible for 20% of the costs.

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What does Medicare Part B cover for Mental Health?

When it comes to Mental Health Services, Medicare Part B is very comprehensive and covers inpatient, outpatient and partial hospitalization. Medicare Mental Health Services help with depression and anxiety for seniors. A general list of common covered services include (but are not limited to);

  • One (1) depression screening per year
  • Family counseling
  • Psychiatric evaluation
  • Annual wellness visit with your doctor
  • Diagnostic tests
  • Certain prescription drugs that aren’t usually “self administered”
  • Individual and group psychotherapy with doctors

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What does Medicare Part B cover for Second Surgical Opinions?

A Surgical second opinion is another doctors advice on a health issue and how it could be treated. Normally, this has to do with some non-emergency surgeries. One can get a 3rd opinion covered if both surgical opinions do not agree.

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What does Medicare Part B cover for Limited Outpatient Prescription Drugs?

Part B may cover a limited number of outpatient drugs under limited conditions. Normally, these drugs are not administered by yourself (ie: within an inpatient/outpatient setting). A general list of common covered services include (but are not limited to); For coverage, GET QUOTE

  • Drugs used with an item of durable medical equipment (DME)
  • Some antigens
  • Injectable and infused drugs
  • Shots (vaccinations)
  • Transplant / immunosuppressive drugs
  • Oral cancer drugs
  • Oral anti-nausea drugs
  • For more information visit Outpatient Drugs .Gov Page

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What determines Medicare Part B Benefits?

There are three (3) main factors that determine Medicare Part B benefits which are;

  • Federal & state laws.
  • National coverage decisions made by Medicare.
  • Local coverage decisions made by companies in each state. These companies decide whether something is medically necessary and should be covered in their area.

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In Conclusion

Part B is senior Medical Insurance that is funded through FICA taxes. Most everyone pays a monthly premium for Part B unlike Part A which is normally free. Part B is 1/2 of Original Medicare, Part A (Hospital Insurance) being the other half. One cannot be on both Medicare Advantage and Part B (Original Medicare) at the same same time. Medicare Part B is comprehensive coverage but does not cover certain health care costs which would require a Medicare Supplement Plan and Part D Prescription for a “Complete Health Plan”. One should always ask if their medical procedures are covered under Medicare assignment to avoid personal costs. Individuals are automatically enrolled in Part B upon turning 65 or collected early if disability. Medicare still has a long way to innovate in health care as it continues to make constant changes since early inception in 1965. If you have questions about your Medicare Part B you can contact a dedicate Bridge Agent to walk you through your Plan options today! This concludes our 2019 Guide on Medicare Part B Explained. Thank you for reading and we hope you continue our trek on the Medicare Journey to the next page link below.

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