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What is Medicare Part B?

  • Medicare Part B is the medical insurance portion of Medicare coverage.
  • Medicare Part B covers two type of medical service - preventive services and medically necessary services
  • Preventative services are those needed to keep potentially severe diseases from advancing
  • Medically necessary services are needed to treat a disease or condition
  • Seniors are the main beneficiary of Medicare Part B
  • Citizens with specific disabilities can also qualify at any age

Part B: Medical Insurance

The federal Medicare laws cover the vital areas needed to provide comprehensive medical care to older Americans. Medicare Part B covers payment for services and medical supplies that are necessary to treat a disease or condition.

Part B Medical Insurance

What does Medicare Part B cover?

In a short phrase, Medicare Part B covers two types of medical services — preventive services needed to keep potentially severe diseases from advancing and medically necessary services needed to treat a disease or condition.

The connection between prevention and treatment became more certain when the Affordable Care Act expanded Medicare coverage by adding new areas of prevention, testing, and screening.

Medicare subscribers got additional coverage at no costs including valuable lab work, diagnostics, and follow-on procedures.

The key concept in improving national health and reducing healthcare costs is that wellness is preferred to treatment and healing diseases.

Part B Medical Insurance

Medically Necessary Services

Medical experts and doctors determine what is needed to diagnose and treat an existing disease or condition, which would be considered medically necessary services.

Part B health insurance covers these services in nearly every situation, which is the primary advantage of treatment under Part B. Standards of care expand as clinical research and technological innovation gradually rises, changing the applicable standards.

Part B Medical Insurance - Preventive Healthcare

Preventive Services

Preventative services include screenings and tests. Early detection and treatment efforts help diminish the impact of severe disease — including untreated mental illness, alcohol abuse, and drug addiction.

Medicare Part B provides an essential layer of the national effort at limiting the impact of severe disease by early detection and treatment. It promotes social medicine concepts like wellness and health education.

Part B Medical Insurance

Part B Comprehensive Insurance Coverage

Medicare medical insurance, Part B also covers clinical research, which is a tool for innovation in medical care. Ambulance services and durable medical equipment are additional benefits part of the foundation of complete medical care covered by Part B.

Part B may also cover some costs in certain qualifying clinical research. Clinical research often uses diagnostic test, surgeries, medicines, or other types of care to find which treatment benefits patients.

Part B Medical Insurance - Mental Health

Treating Mental Illness As We Treat Physical Illness

The philosophy of Medicare is to treat mental illness like any similar physical condition. Part B covers the these listed mental health screenings and care categories:

  • Inpatient treatment is hospitalization within the meaning of Part A Medicare. It also occurs as Part B in follow-on care in fields like detoxification and treatment for drug and alcohol addictions.
  • Outpatient treatment services under Part B are an important part of services provided to combat alcohol and drug addiction.
  • Partial hospitalization is an important attribute for treating mental health issues. It offers a more intense focus than counseling and other outpatient therapies; it is a mode of choice when treatment does not require overnight hospitalization.
Part B Medical Insurance - Enrollment

How do I get Part B coverage?

The Initial Enrollment Period (IEP) is the first opportunity for most applicants to sign up. This eligibility is based on age, and it is a seven-month period surrounding the 65th birthday month.

People can sign up for Medicare A and B from three months before the birthday month, during the birthday month, and for three months after the birthday month.

Part B Medical Insurance - Open Enrollment

What do I do after the IEP?

The next opportunity after the IEP may be the Annual General Enrollment Period for Medicare Part B — from January 1st through March 31st each calendar year. If taking this option, an applicant may have to pay a late application fee.

Any change in the life circumstances such as a change of location or loss of employer or union-sponsored coverage can generate a special enrollment period.

If eligible, an applicant can avoid paying a late fee and sign within the time frame of a special enrollment period.

Part B Medical Insurance

What Affects Out-of-Pocket Costs?

In medical insurance, out-of-pocket costs have three primary sources. Consumers must:

  1. Pay until they reach the deductible limit.
  2. Pay for charges beyond the insured coverage.
  3. Pay for services that insurance does not cover.

Out of pocket costs formerly had no limits in until health plans were reformed through the Affordable Care Act. The ACA added many free services to Medicare particularly in prevention such as annual screenings, tests, and mental health coverage. The numbers of services and medical support activities included in essential benefits at no additional charge have a positive effect on out-of-pocket costs. Part B deductible and coinsurance percentages directly affect the amount of out-of-pocket costs.

Medicare Part B subscribers typically pay 20% of the Medicare approved amount for most doctor services including outpatient therapy and durable medical equipment.

Part B Medical Insurance

Is there a Late Enrollment Penalty for Part B?

Those who delay in signing up for Medicare Part B could face a penalty. The penalty is based on time without coverage. The penalty goes on for as long as the applicant has Part B. The penalty is as follows below. Penalty- Up to ten percent increase in premiums per year.

  • Penalty – Up to ten percent increase in premiums per year
  • Term – Applied for each 12 month period one could have but did not have Plan B coverage

People with special enrollment periods can avoid a late penalty, and those with limited income can get relief from the state government to pay Part A and or B. They may get relief from aid to pay prescriptions as well.

References:

  1. https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html, “What Part B covers,” Jul 1, 2016.
  2. https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html, “Preventive visit & yearly wellness exams,” Jul 1, 2016.
  3. https://www.medicare.gov/coverage/preventive-and-screening-services.html, “Preventive & screening services,” Jul 1, 2016.
  4. https://www.medicare.gov/coverage/clinical-research-studies.html, “Clinical research studies,” Jul 1, 2016.
  5. https://www.medicare.gov/coverage/outpatient-mental-health-care.html, “Mental health care (outpatient),” Jul 1, 2016.
  6. https://www.medicare.gov/coverage/partial-hospitalization-mental-health-care.html, “Mental health care (partial hospitalization),” Jul 1, 2016.
  7. https://www.medicare.gov/coverage/smoking-and-tobacco-use-cessation.html, “Smoking & tobacco use cessation (counseling to stop smoking or using tobacco products),” Jul 1, 2016.
  8. https://www.medicare.gov/coverage/your-medicare-coverage.html, “Didn’t find what you’re looking for?,” Jul 1, 2016.
  9. https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html, “Part A & Part B sign up periods,” Jul 1, 2016.
  10. https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html, “Part B costs,” Jul 1, 2016.
  11. https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html, “How do I get Parts A & B?” Jul 1, 2016.
  12. https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156, “Should I get Parts A & B?,” Jul 1, 2016.
  13. https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html, “What’s Medicare Supplement Insurance (Medigap)?,” Jul 1, 2016.
  14. https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html, “How to compare Medigap policies,” Jul 1, 2016.
  15. https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html, “Medigap & travel,” Jul 1, 2016.
  • Check out the following links to learn more about Medicare
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