For those in the United States who are at least 65 years old, disabled, or have ALS (Lou Gehrig’s disease) or end-stage renal disease (ESRD), Medicare is a federal health insurance program. It is divided into Parts A, B, C, and D.
The part of Medicare that most closely resembles conventional health insurance is known as Part B and is referred to as medical insurance. Let’s examine what is covered by Medicare Part B.
What Medicare Part B Covers
In summary, Medicare Part B covers outpatient/medical treatments, many of which are cost-free but some are subject to a deductible and charge. What does that actually mean? Here are some specifics.
Preventive Services
Vaccination Services as long as you see a physician or other healthcare professional who accepts assignment (i.e., who will take the Medicare-approved amounts as full payment), preventive healthcare services are normally provided without charge. The following are examples of the services that can be used to stay healthy, avoid illness, and identify conditions:
- Bone density measurements
- Cardiovascular disease screenings
- Mammograms
- Cancer screenings (such as for cervical, colorectal, or prostate)
- Depression screenings
- Diabetes screenings
- Flu shots
- Glaucoma tests if you’re considered to be at high risk for this disease
- A yearly “wellness” visit
Other Medically Necessary Services
Medicare Part B also assists in providing coverage for additional services or items required to treat or identify a medical condition. For instance, medical professionals’ services, home health care, outpatient care, and durable medical equipment.
Here are a few instances:
- Ambulance services
- Cardiac rehabilitation
- A portion of outpatient chemotherapy
- Implanted defibrillator
- Diabetes supplies
- Durable medical equipment like oxygen equipment, wheelchairs, and walkers
- Certain types of medically necessary home health services
- Kidney dialysis and supplies
- Physical therapy
- Second surgical opinions
- Tests such as MRIs, CT scans, EKG/ECGs, and a CPAP trial for up to three months if you’ve been diagnosed with obstructive sleep apnea
- Lab services, such as blood tests, urinalysis, and tests on tissue samples
Additional services might possibly be included in this list, which is not all-inclusive.
These frequently have a deductible and a fee, unlike preventive procedures (20 percent of the Medicare-approved cost). Furthermore, there is no annual cap on the amount that you may be required to pay out-of-pocket for medical treatments under Part B.
What Isn’t Covered by Medicare Part B
Prescription medicines, skilled nursing facility care, hospice care, and inpatient hospital treatment are all covered by other Medicare components but not by Medicare Part B.
A few key care categories are also not included. For instance, no part of Medicare Parts A and B covers the majority of dental treatment, including dentures. Additionally, Medicare Parts A and B do not cover cosmetic surgery, hearing aids, fitting exams for hearing aids, eye exams related to prescribing glasses (but not linked to a disease or concern), or concierge services. Additionally, long-term care is not listed as a covered service.
Long-Term Care
Long-term care also referred to as “custodial care,” is non-medical assistance with the six activities of daily living (bathing, dressing, eating, transferring, toileting, and continence).
Medicare Parts A and B are not the only sources of this lack of coverage. According to the Centers for Medicare & Medicaid Treatments, the majority of health insurance policies, including Medigap coverage, do not pay for these services.
A percentage of the expenditures for skilled nursing facility care is covered by Medicare Part A, but only when the patient is an inpatient and not on a long-term basis. Due to a condition or illness, many patients require expert nursing home care but do not satisfy the minimum hospital stay requirement. If this applies to you, you can’t rely on Medicare Part A or Part B to fund nursing home or long-term care costs in your situation.
Medicare Advantage (MA) Plans
The Medicare Advantage (MA) Plans, sometimes referred to as Medicare Part C, are private health insurance programs that have received Medicare’s approval.
In addition to Medicare Parts A and B, they frequently also contain Part D and additional benefits not offered by Medicare plans. For instance, it’s typical for MA plans to cover dental, vision, and hearing needs. With a yearly out-of-pocket cap, they might also provide lower out-of-pocket expenses. You must, however, usually use doctors who are part of the plan’s network.
How To Enroll in Medicare Part B
Ready to enroll in Medicare Part B? Here are the steps to follow:
Check Your Eligibility
You must first be eligible for any Medicare benefit before you can enroll. Typically, three months before you turn 65, you become eligible. However, if you have a disability, ESRD, or ALS, you might be eligible sooner. Furthermore, you need to be qualified for benefits based on your income or the income of your kid, spouse, or parent.
Enroll During an Enrollment Period
Only during initial enrollment, general enrollment, or special enrollment periods are you able to sign up for Medicare Part B.
- Initial enrollment period (IEP): A seven-month period that starts three months before you turn 65 and ends three months after.
- General enrollment period: An annual enrollment period that runs from January 1 to March 31. Part B and Premium Part A coverage begin July 1 of that same year.
- Special enrollment period: An eight-month period that starts when employment or group health plan coverage ends.
Check Also:
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Frequently Asked Questions (FAQs)
How do you sign up for Medicare Part B?
By going to the Social Security website, you can enroll in Medicare Part B. You can also mail a form in, visit your local Social Security office, or phone Social Security at 1-800-772-1213 (or 1-800-325-0778 for TTY users).
How much does Medicare Part A cost?
How much does Medicare Part B cost?
