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What You Need To Know About Medicare Part B

Making the transition from one insurance to another is rarely difficult, but when you add the stress of retirement, relocating, alteration in finances or other lifestyle changes to that transition many seniors quickly find themselves uncertain and overwhelmed. And so can those who juggle the management of their own career and family lives with the added responsibility of assisting a parent in making wise choices. Switching to Medicare insurance is not difficult once you understand the procedure and options available.

In most circumstances, you are enrolled in Medicare Part A when you reach age 65, and enroll in Part B the same time, or, if you are still working, when you are no longer going to be covered by employer insurance. There is a penalty for late enrollment in Part B.

If this is the year you or a loved one turns 65, chances are that a Medicare & You 2018 book will arrive by mail. This is the official Medicare handbook sent to every Medicare household in September of each calendar year, right before the October open enrollment period. Most of these publications carry information for plans specific to the state in which you live as well. This handbook summarizes your benefits and rights under Medicare, identifies the changes that will take place in January of the next year and provides official definitions for many terms that you will need to understand.

Please note that there are a number of special circumstances that affect how and when Medicare begins for a recipient. Examples include, if you are under 65 and disabled, suffer from ALS or receive railroad retirement benefits. The following information is applicable to most Medicare enrollees.

Original Medicare consists of:

  • Part A – Hospital Insurance
  • Part B – Medical Insurance

What is Medicare Part B and What Does it Cover?

Medicare Part B helps cover medically necessary physician services. This would include your primary care doctor and most specialists' office visits.  Outpatient care, mental health services, home health services, durable medical equipment (DME) and many preventive services are paid under part B.

Part B also covers:

  • Screening mammograms to check for breast cancer,
  • Comprehensive cardiac rehabilitation (when certain conditions are met)
  • Colorectal cancer screenings
  • Diabetes screening (if your doctor determines there is a risk)
  • Chemotherapy
  • CPAP
  • Advance care planning
  • Chronic care management services

Part B does not cover:

  • Eye exams related to prescription glasses
  • Dentures or dental care
  • Hearing aids and exams for fitting them
  • Acupuncture
  • Cosmetic surgery

The actual dollar amount of a service Plan B will cover depends upon whether your physician accepts assignment. This means your doctor/provider agrees to accept the Medicare-approved amount as full payment for the service they render. Sometimes, this is referred to as participating in or with Medicare. A non-participating provider may require you to pay the entire charge for a service at the time you receive it; they can also charge you more than the Medicare-approved amount.

What is the Cost of Medicare Part B?

Medicare Part B recipients pay a standard monthly premium, must meet their annual deductible and are expected to pay a coinsurance of cost for services rendered.

  • The standard monthly premium for 2018 for most Part B recipients in $134; for convenience, this amount is usually deducted from the Social Security benefit they receive each month.
  • The deductible for 2018 is $183. This is the amount of out-of-pocket you will be expected to pay before your Original Medicare begins to pay. Most physician offices require you to pay the deductible (if there is one) at time of service.
  • The coinsurance will vary dependent upon the services rendered and in what setting, but is usually approximately 20% of the cost of the service.

For example, a 70-year-old man with high blood pressure and diabetes has chest congestion and visits his primary care physician on January 12. Since his physician must consider both those chronic conditions when deciding how to treat the problem, the Medicare-approved cost of the office visit is $223. The patient has not yet paid any of the $183 deductible for this calendar year and so may be asked to pay $183 out of pocket and Medicare is billed for most of the remaining $40. When our patient returns for a follow-up visit in two weeks time, since that deductible has already been paid he will be responsible only for the 20% coinsurance.

Medicare regularly sends you a Medicare Summary Notice for Part B (Medical Insurance) which notifies you of claims processed, how much of your deductible you have already paid, what services Medicare was billed on your behalf, what they paid and the amount you can be required to pay.

Medicare Part B Enrollment

You can apply for Medicare Part B using one of the following methods:

  • Online at socialsecurity.gov.
  • In person at your local Social Security Office. Call your local office to schedule an appointment.
  • By phone at 1-800-772-1213. The hours of availability for this number are Monday-Friday from 7 AM- 7 PM.

Things to Consider When Enrolling in Part B:

  • Accessibility and convenience of physician's offices.
  • Availability of transportation to physicians office and other outpatient venues.
  • Ancillary care needs and availability in the area of same.
  • Is the enrollee up to date with eyeglass/eye exams and dental? Original Medicare doesn't cover these.

Securing the best insurance and appropriate level of care for a parent requires careful review of the realistic expectations of their level of independent function. The emotional impact a major change can generate is stressful, but manageable if all parties take their time to review what is available, what is reasonable and what provides the most comfortable environment possible. You should consult a professional when considering any type of insurance or health coverage.

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