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Understanding Medicare Part B

Medicare Part B is considered the doctors’ services or the medical services coverage portion of Medicare. This part of Medicare covers items such as an enrollee’s doctor visits, as well as outpatient care.

Other items such as preventive care are also covered by Medicare Part B, as is clinical research studies that will test different types of medical care. The preventive services that are covered can help to detect illness at an early stage when the treatment is the most likely to work the best for an individual. There are also supplemental plans out there that you can in enroll in to help cover the costs that Medicare does not cover, such as Plan F Medicare Supplement coverage and Plan G Medicare Supplement coverage.

Medicare Part B on board

What Does Medicare Part B Cover?

Medicare Part B covers a wide variety of different benefits. In addition to doctors’ services, these can include the following:

  • Durable Medical Equipment – The durable medical equipment (DME) that is covered by Medicare Part B is that which is prescribed by a doctor to be used in the enrollee’s home. It is considered to be long-lasting, and it must be used for a medical reason.
  • Clinical Research – Clinical research may also be covered by Medicare Part B. This can include research studies that test different types of drugs and / or medical procedures. As an example, this could include determining how well a certain type of cancer medication may work for an individual. Such studies can help medical professionals and researchers to learn whether or not new types of treatment will work, as well as to learn if they are safe. A Medicare enrollee may be required to pay 20 percent of the Medicare-approved amount, depending on the treatment that is received. Also, the Medicare Part B deductible may also apply.
  • Mental Health – Mental health services are also covered under Medicare Part B. This can include mental health services and visits from health professionals like psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physicians. Mental health counseling will only be covered by Medicare Part B, however, when the provider accepts Medicare assignment.
  • Ambulance Services – Part B of Medicare also covers emergency ground transportation when an enrollee requires transportation to either a hospital, a critical access hospital or a skilled nursing facility. This will occur when the individual has had a sudden medical emergency, and his or her health is in serious danger, and they are unable to be transported by any other means.
  • Obtaining a Second Opinion before Surgery – Medicare Part B will cover the cost of obtaining a second opinion prior to an enrollee’s surgery in certain instances when the surgery is not considered to be an emergency. A second opinion occurs when a doctor other than the enrollee’s regular doctor provides him or her with their opinion regarding the issue and how it should be treated. Medicare Part B may also even cover the cost of obtaining a third opinion, provided that the first and the second opinions differ from one another.

How Much Does Medicare Part B Cost?

There is a monthly premium that is required for obtaining Medicare Part B coverage. Most enrollees will pay $104.90 per month for this coverage (in 2016), provided that they have their Part B premium withheld from their Social Security. Others who have not yet enrolled in Social Security, or who will enroll in Medicare in 2016, will pay a monthly premium of $121.80 per month for Medicare Part B. However, if a person’s modified adjusted gross income from two years prior is considered to be in an upper-income level, and then he or she may be required to pay a higher premium amount.

For example, the chart below shows what an enrollee would be required to pay in Medicare Part B premium per month for 2016, based on their 2014 modified adjusted gross income, as well as the way in which they file their annual tax return.

Individual Tax Return (for 2014)   Joint Tax Return (for 2014)   Married and File a Separate Tax Return (for 2014)   Your Part B Premium (in 2016)

Medicare Part B Costs

Individual Tax ReturnJoint Tax ReturnMarried and File a Separate Tax ReturnYour Part B Premium
$85,000 or less$170,000 or less$85,000 or less$121.80
Above $85,000 up to $107,000Above $170,000 up to $214,000 N/A $170.50
Above $107,000 up to $160,000Above $214,000 up to $320,000 N/A $243.60
Above $160,000 up to $214,000Above $320,000 up to $428,000 N/A $316.70
Above $214,000 Above $428,000 N/A $389.80

Medicare Part B also has many out-of-pocket copayment and coinsurance charges, as well as an annual deductible. For 2016, enrollees pay an annual deductible for Medicare Part B of $166. After the Part B deductible has been met for the year, an enrollee will usually pay 20 percent of the Medicare-approved amount for most of his or her doctor services – including most of their doctor services if they are being treated as an inpatient in the hospital, and while they are having outpatient therapy. This also holds true about the cost of durable medical equipment.

Help With Paying Medicare Part B Expenses

Due to the high cost of Medicare Part A and B out-of-pocket deductibles, copayments, and coinsurance, many people turn to Medicare Supplement insurance for help in paying these expenses. Having this type of coverage can take a large financial burden off of a Medicare enrollee and transfer it to an insurance company in exchange for only the cost of a monthly premium.

Medicare Supplement is a type of insurance coverage that is designed specifically for filling in the gaps in coverage that Medicare leaves. This is why Medicare Supplement insurance is often referred to as Medigap.

Medicare Supplement insurance is not offered through Medicare itself, but rather via private insurance companies that are approved by Medicare. Currently (in 2016), there are ten different Medicare Supplement insurance plans to choose from. The plans are named after letters of the alphabet, with Plan A offering the most basic set of “core” benefits, and the other plans providing these core benefits, along with additional options.

Plan A’s coverage provides the following benefit items:

  • Medicare Part A coinsurance and hospital costs, up to an additional 365 days after Medicare’s benefits have been used up;
  • Medicare Part B coinsurance or copayment;
  • Blood – first three pints;
  • Medicare Part A hospice care coinsurance or copayment.

For those who are seeking more comprehensive Medicare Supplement insurance coverage, there are options available. Plan F, for example, provides all of the same coverage as Plan A, along with the following additional benefits:

  • Skilled nursing facility care coinsurance
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Medicare Part B excess charge
  • Foreign Travel Exchange

Only those who are enrolled in Medicare Part A and Part B – Original Medicare – are able to purchase Medicare Supplement insurance coverage. This means that if an individual is enrolled in Medicare Advantage, they are not eligible for this type of coverage.

Medicare Advantage – An Alternative to Medicare Part A and Part B

For those who wish to receive their Medicare benefits in a different manner, Medicare Advantage – or Medicare Part C – may be a good option. When enrolled in Medicare Advantage, an individual will still receive all of the coverage that they have with Medicare Part A and Part B. However, they may also be eligible to receive additional coverage, as well, such as dental, vision, and / or wellness benefits, too.

With Medicare Advantage, there may or may not be a premium involved. It may also be required that the enrollee visit the healthcare providers that are listed within a particular network and / or obtain a referral prior to visiting a specialist for various medical treatments.

How to Get the Best Premiums on Medicare Supplement Insurance Coverage

When you are seeking the best premiums on Medicare Supplement insurance coverage, it is typically best to work with either a company or an agency that has access to more than just one insurance carrier. This is because, while the benefits on Medigap plans of the same corresponding letter are required to be identical, the premiums can differ a great deal from one insurance company to another. Therefore, it is important shop around before you make your final purchase decision.

Should you find that you still have any questions regarding Medicare Supplement insurance, Medicare Part B – or even about Medicare in general – please feel free to contact us directly. Our experts are here to assist you with the questions and concerns that you may have. We can be reached via phone, toll-free, by dialing 800-376-0824.

You have many options when it comes to getting Medicare Supplement insurance coverage – so you will want to ensure that you get what’s right for you regarding benefits and premium price. So, contact us today – we’re here to help.

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