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Overview of Medicare Part B

Medicare Part B provides coverage for medically necessary doctor’s services, outpatient care, and most other services that Part A does not cover such as some physical or occupational therapies and some home health care services.  Part B also covers preventive services.  The following is a list of items and services which can be covered under Part B:

  1. Physicians’ services;
  2. Home Health Care;
  3. Services and supplies, including drugs and biologicals which cannot be self-administered,furnished incidental to physicians’ services;
  4. Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests;
  5. X-ray therapy, radium therapy and radioactive isotope therapy;
  6. Surgical dressings, and splints, casts and other devices used for fractures and dislocations;
  7. Durable medical equipment;
  8. Prosthetic devices;
  9. Braces, trusses, artificial limbs and eyes;
  10. Ambulance services;
  11. Some outpatient and ambulatory surgical services;
  12. Some outpatient hospital services;
  13. Some physical therapy services;
  14. Some occupational therapy;
  15. Some outpatient speech therapy;
  16. Comprehensive outpatient rehabilitation facility services;
  17. Rural health clinic services;
  18. Institutional and home dialysis services, supplies and equipment;
  19. Ambulatory surgical center services;
  20. Antigens and blood clotting factors;
  21. Qualified psychologists’ services;
  22. Therapeutic shoes for patients with severe diabetic foot disease;
  23. Influenza, Pneumococcal, and Hepatitis B vaccine;
  24. Some mammography screening;
  25. Some pap smear screening, breast exams, and pelvic exams;
  26. Some other preventive services including colorectal cancer screening, Diabetes training tests, bone mass measurements, and prostate cancer screening.

Though Medicare Part B is fairly comprehensive, it is far from complete. There are certain items and services which are excluded from coverage.  The excluded services include:

  1. Services which are not reasonable or necessary;
  2. Custodial care;
  3. Personal comfort items and services;
  4. Care which does not meaningfully contribute to the treatment of illness, injury, or a malformed body member;
  5. Prescription drugs which do not require administration by a physician;
  6. Routine physical checkups;
  7. Eyeglasses or contact lenses in most cases;
  8. Eye examinations for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses;
  9. Hearing aids and examinations for hearing aids;
  10. Immunizations except for influenza, pneumococcal and hepatitis B vaccine;
  11. Cosmetic surgery;
  12. Most dental services;
  13. Routine foot care.

Most people have to pay a premium for Part B.  A person can check to see if he/she is qualified to receive help from the state to pay for premiums or deductibles.  Otherwise, the premium is usually deducted from a person’s Social Security, Railroad Retirement or Civil Service Retirement check.  A Part B premium can also be paid every quarter, through the electronic payment option or Medicare Easy Pay.

Part B of Medicare will pay 80% of the “reasonable charge” for covered services if the beneficiary meets the annual deductibles.  The beneficiary should then pay the remaining 20% as “co-insurance.”  The “reasonable charge,” however, is often less than the provider’s actual charge.  If the provider agrees to “accept assignment,” he agrees to accept Medicare’s “reasonable charge” rate as payment in full and the patient is only responsible for the remaining 20%.  If the provider does not accept assignment, the patient will be responsible for paying a portion of the difference between Medicare’s reimbursement rate (the reasonable charge) and the provider’s actual charge.

Since 1972, individuals receiving Social Security retirement benefits, individuals receiving Social Security disability benefits for 24 months, and individuals otherwise entitled to Medicare Part A, are automatically enrolled in Part B unless they decline coverage.  Others must enroll in Part B by filing a request at the Social Security office during certain designated periods.

Overall, Medicare Part B provides additional coverage which helps minimize health care insurance worries.  Medicare’s Part B is optional and is financed largely by monthly premiums paid by individuals enrolled in the program.  Since 2007, for the first time in the history of the Medicare program, the premium has been income based.

Inside Overview of Medicare Part B