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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 medical insurance.

It is the payment system for medical services providers who care for Medicare subscribers. Medicare Part B covers payment for services and medical supplies that are necessary to treat a disease or condition.

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.

Medically Necessary Services

AdobeStock_25075759-1600x1600Medical experts and doctors determine what they need to do to diagnose and treat an existing disease or condition. In Medicare B, this process is considered a medically necessary service.

Part B covers these services in nearly every situation, which is the primary advantage of treatment under Part B. It is a comprehensive approach to medical care.

This standard grows as clinical research and technological innovation gradually rise or change the applicable standards.

Preventive Services

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.

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

Part B Comprehensive Insurance Coverage

Medical Insurance under Part B has a significant effect on the health of a large population of older Americans. It provides limited outpatient prescription drugs and added basic protections like getting a second opinion before surgery.

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

Treating Mental Illness As We Treat Physical Illness

AdobeStock_60058190-1600x1600The 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.

– Coverage Grows Over Time

The sources of authority for Medicare B coverage come from the Congress. It must authorize the benefits and name beneficiaries of increased funds and attention to medical needs.

The enormous costs and human costs of tobacco usage in the US made it a priority for the long-term goals of improving national health and containing costs.

– There are Many Sources of Leadership

The federal Medicare administration (the Centers for Medicare and Medicaid) make national policy decisions on coverage of diseases and conditions including incorporating new technology and equipment.

The companies and offices that process claims make local coverage decisions and input technical information that form standards.

For example, a transformation in health costs and prospects rests with programs such as smoking cessation. The local level is also a source of innovation in the approved methods, equipment, and approaches for success.

Should I get Medicare Part B?

Every eligible person will benefit from coverage under Medicare Part B. The high quality and low costs meet or exceed those available in the private sector. The nearly universal acceptance of Medicare offers a wide range of facilities, professionals, and locations.

It covers the things needed to treat a condition or illness including doctor visits, laboratory tests, and medical equipment.

The other vital role is in prevention and screening for severe diseases before they start. Prevention is a key! Medicare Part B is an excellent investment in health.

How do I get Part B coverage?

The Initial Enrollment Period (IEP) is the first opportunity for some 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.

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 30th 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.

How Much Does Medicare Part B Cost?

AdobeStock_62082716-1600x1600 (1)The costs of Part B depend on the premiums that apply to the applicant’s situation. Medicare Part B premiums can vary from year to year. For a large number of applicants, the premium is paid from social security benefits automatically by direct deduction.

According to Medicare.gov in 2018: “The standard Part B premium amount in 2018 will be $134 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount ($130 on average).”

In certain situations, you may pay higher than $134, so we recommend review Medicare.gov’s cost breakdown carefully.

IRMAA Adjustments for High-Income Earners

Most subscribers will pay a standard premium amount of $134. However, if the modified adjusted gross income as reported on the IRS tax return from two years prior filings is above a certain income amount, then taxpayers may pay an Income Related Monthly Adjustment Amount (IRMAA).

IRMAA is an extra charge added to the Medicare B premium. The amount can vary from $134 and up on incomes from $85,000 or more.

What Affects Out-of-Pocket Costs?

In medical insurance, out-of-pocket costs have three primary sources. First, consumers must pay until they reach the deductible limit. Second, consumers must pay for charges beyond the insured coverage. Third, consumers must 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.

Just as important, 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. These services do not add to consumer costs. Part B deductible and coinsurance percentages directly affect the amount of out-of-pocket costs

Subscribers will pay $166 per year for the Part B deductible. After paying the Part B deductible, subscribers pay 20 percent of the Medicare-approved amount for most doctor services, which includes doctor services provided to hospitalized inpatient subscribers.

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

Some services can cause short supply due to an overall national difficulty in recruiting and retaining personnel. In 2016, there may be limits on physical therapy, occupational therapy, and speech-language pathology services. If so, there may be exceptions to these limits.

When should I enroll in Part B?

To gain the maximum benefit and risk no penalty, one should enroll at the earliest possible time. For most applicants, the earliest time is the IEP for Part B. Preexisting coverage through an employer, spouse, or a union-sponsored plan may affect the IEP.

Those who have coverage during their IEP will get a new enrollment opportunity when needed due to a life change. They can avoid the penalty when joining later with a Special Enrollment Period.

Those with existing coverage get a grace period for signing up with Plan B. For many applicants, the price and system for employer-sponsored services or union group services are favorable. Payments may be built-in with benefits and applicants would fare better keeping an existing arrangement.

Those who lose coverage will have a special enrollment period related to the specific loss of coverage from the job or union-sponsored plan. Many people wish to hold on to an employer or union-sponsored plans. These sometimes offer attractive terms of payment.

What’s the 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 too.

How does the Medigap Open Enrollment Period work?

AdobeStock_65704664-1600x1600The best time to purchase Medigap insurance is during the first six months of eligibility. During the initial Medigap open enrollment, consumers may purchase any Medigap policy sold in their state regardless of the buyer’s health conditions.

The Medigap rules permit sellers to use medical underwriting when developing Medigap policies for sale. There is an exception for the initial Medigap enrollment period. Everyone can purchase the policies on the most favorable terms, such as those offered to healthy customers.

The initial Medigap Open Enrollment period begins with the 65th birthday and enrollment in Medicare Part B.

From that date, you have a six-month window in which to purchase Medigap insurance, which is the first Medigap open enrollment.

Consumers no longer have a right to buy Medigap after the initial open enrollment. They also no longer get the right to purchase at the best available price. Sellers may restrict the policy to those in good health only and at premium prices.

What is Medigap?

Medicare Supplement insurance policy (Medigap) is a set of protections sold through private companies. The basic purpose of Medigap is to pay the amounts that Medicare does not pay.

Medigap pays only the types of payments excluded by original Medicare — including coinsurance, copayments, and deductibles.

Foreign sources of medical care may be unlikely to accept assignments from US Medicare. They may insist on collecting the full balances due. Medigap can reduce any potential consumer liability by paying some or all of the uncovered amounts after Medicare set maximum coverage limits.

– Medigap Is Gap Insurance Only

Medigap is not a Medicare Plan; it does not offer protections for events and coverages for medical services. It is only an undertaking to pay amounts excluded by Medicare. The Medigap insurance is secondary to Medicare.

It only pays after Medicare; it only pays the amounts allowed but not paid by Medicare. The purpose of Medigap is to limit the exposure of the consumer to amounts approved but not paid, assigned, or covered by Medicare.

– Medigap Foreign Travel Advantages

Another area of use for Medigap is in travel outside of the United States. Medical emergencies can arise at any time or place. Medicare does not cover all contingencies, and Medigap can pay charges that Medicare does not cover. Once one satisfies a $250 deductible, some policies pay 80 percent of coverage that Medicare does not provide.

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/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html, “How Original Medicare works,” Jul 1, 2016.
  12. 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.
  13. 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.
  14. https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html, “Part B late enrollment penalty,” Jul 1, 2016.
  15. https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html, “When can I buy Medigap?,” Jul 1, 2016.
  16. https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html, “What’s Medicare Supplement Insurance (Medigap)?,” Jul 1, 2016.
  17. https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html, “How to compare Medigap policies,” Jul 1, 2016.
  18. https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html, “Medigap & travel,” Jul 1, 2016.

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MULTIPLAN_GHHK5LLEN_Accepted Last Updated 3/18/2018