Medicare has four different parts, and each part covers and works differently. If you’re eligible for Medicare and thinking of getting enrolled, it’s highly recommended for you to get to know what services it covers. Understanding what Medicare is and its coverage will help you plan and prepare for future medical services you might need.
What Is Medicare
Medicare is a voluntary health insurance policy for those aged 65 and up, for younger people with disabilities, people with end-stage renal disease, and those who have ALS (Amyotrophic lateral sclerosis). It has different parts, one of which is Part B.
What Is Medicare Part B
Part B of Medicare is the part of the program that most closely resembles conventional health insurance. It’s a part of Medicare that covers outpatient services. Medicare Part B coverage includes doctor’s office visits and outpatient laboratory services, which helps its beneficiaries stay healthy. It also covers preventive services, like annual physical exams and vaccines.
Medicare Part B: Eligibility, Premium, And Coverage
Medicare can be complicated at first. This is why you need to understand its basics like when to enroll, its coverage, and how its premium payment works.
Medicare isn’t mandatory. You can either choose to enroll or not, depending on your needs. Medicare Part A is free for the vast majority of Americans who’ve served in the United States for several years and are thus paying payroll taxes. Meanwhile, Part B isn’t free, and you need to pay a monthly premium for it.
Once you turn 65 years old, you’re eligible to enroll to Medicare Part B. If you’re a person with a disability receiving social security disability benefits for two years or have end-stage renal disease or ALS, you’re eligible too.
Part B doesn’t allow automatic enrollment for some. An eligible individual can opt-out of it. If you’re still working under a small employer, you have two options. You can choose to opt-out of Medicare and stay with your group. You can also drop your group plan and enroll to Medicare.
Medicare Part B covers outpatient services, but you have to keep in mind that it doesn’t cover everything.
Part B usually covers this type of service at the full amount. Examples of preventive services are flu shots, cancer screening, annual physical exams, and mammograms.
This only applies to medically necessary outpatient services. You must remember that, unlike preventive service, Part B won’t qualify outpatient services at 100%. You still need to pay your deductible, whatever the percentage is, before your Part B coverage for this type of service kicks in. A deductible is an amount that you need to pay on top of your Part B premium for Medicare to pay a portion of the service’s charges.
Some covered services include, but are not limited to, emergency services, including ambulance transport; rehabilitation services, like physical therapy and occupational therapy; durable medical equipment and supplies; and most laboratory services.
Medicare Part B Coverage Exclusions
Being a government-provided insurance doesn’t mean that it’ll cover all of your medical expenses. Some services are still excluded even if they qualify as outpatient services. Below are some examples of services that fall under Medicare’s Part B coverage exclusion.
Part B covers acupuncture only for a number of visits to treat chronic low back pain. If it doesn’t meet the criteria, it won’t be covered by Medicare. If it meets the requirements, ensure that you won’t exceed the specified number of visits as excess sessions won’t be covered. Medicare won’t also cover your treatments if the pain isn’t improving or just getting worse.
Although Part B covers hearing exams when prescribed by your doctor, hearing aids, as well as the exams for fitting them, aren’t covered.
Also known as long-term care, custodial care is a collection of programs and resources to help you with your care needs. The majority of long-term care isn’t medical. Instead, most long-term care programs consist of assistance with simple personal tasks such as washing, dressing, and using the toilet.
Eye Exams For Prescription Glasses
Routine eye checks aren’t covered by Part B. This is the kind of test you’d have to get fitted for eyeglasses or contact lenses, also known as eye refraction. Medicare Part B doesn’t cover vision exams, eyeglasses (frames or lenses), or contact lenses in the majority of cases.
Medicare offers a lot of advantages, so knowing its parts is crucial to maximize its offered benefits. Part B is one of its vital components as it closely resembles conventional health insurance.
Part B is the part of Medicare that covers outpatient services but not everything. It would help to settle your deductible before your Part B coverage kicks in. Part B isn’t free, and you need to pay a premium to stay active. Consider the non-covered services to avoid unexpected medical bills.