The Basics of Medicare Part B

Medicare’s original program was designed with two parts to provide eligible individuals with hospital insurance coverage and medical insurance coverage. Medicare Part A is the portion responsible for paying an individual’s fees for services and supplies related to hospital stays. Medicare Part B on the other hand is responsible for paying for general medical services such as doctor visits, checkups, and exams. Let’s take a closer look at the basics of Medicare Part B coverage.

Medicare Part B coverage provides beneficiaries with two basic services, medically necessary services and preventative services. Part B covers health services and the supplies necessary to diagnose and combat certain diseases. Medicare will only help pay for services deemed medically necessary. Part B coverage will also pay for preventative services that help to either prevent a disease or diagnose illnesses at an early stage so they can be managed before they get worse.

The list of services that Part B coverage considers medically necessary includes but is not limited to the following:

- Ambulance Services (when necessary and only to the nearest treatment facility)
- Clinical Laboratory Services
- Diabetes Supplies
- Doctors Services
- Occupational/Physical Therapy Services
- Durable Medical Equipment (such as canes, walkers, and wheelchairs)

Even though Medicare Part A is designed to provide hospital insurance, there are provisions under Part B that cover outpatient procedures at hospitals (such as X-rays, casts, and wound management) as well as emergency room services.

Some of the preventative services that Part B will cover include but are not limited to:

- Bone Density Tests
- Cancer Screening
- Diabetes Screening
- Glaucoma Tests
- Smoking Cessation
- Shots

Medicare Part B is not without cost to those enrolled in the program. In addition to a monthly premium to pay for the cost of Part B coverage, beneficiaries must meet a certain deductible amount on their own before Medicare’s Part B coverage will kick in and pay for the rest of the services rendered. Even after meeting the deductible and paying the monthly premium, individuals may have to pay a 20% coinsurance.

There are ways of getting around the gaps in Part B coverage. Individuals can enroll in a Medigap plan that will help pay for certain out of pocket costs such as the deductible, coinsurance, and copayments. Individuals who have limited income and cannot afford the monthly premium for Medicare Part B should consult their State Health Insurance Assistance Program as there are some states that will help low-income individuals pay their monthly premiums.

Medicare Part B coverage is open to anyone who is eligible for Medicare Part A; but unlike Part A, Medicare Part B coverage is optional. If an individual decides to opt out of Medicare Part B coverage they could face a lifetime penalty for choosing to not carry Part B coverage.

Medicare Part B is just a portion of the Medicare program which was designed to provide eligible senior citizens with necessary health insurance during their golden years.