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Medicare Part B

Medicare Part B

Medicare Part B is health insurance for outpatient care and services. It helps you pay for the services you receive that don’t require an inpatient hospital stay.

It also covers most of the doctor fees from services you receive while in the hospital such as open heart surgery or general care. Those fees are not covered by Medicare Part A (in-patient care).

While there are some restrictions, Medicare Part B helps with the cost of:

  • Doctor office visits
  • Emergency or observation services, which may include an overnight stay in the hospital
  • Ambulatory surgery center and outpatient medical services
  • Diagnostic procedures like laboratory test and X-rays
  • Durable medical equipment for use at home

All of the covered services must be medically necessary designed to help you regain your health and mobility.

Medicare Part B doesn’t cover the entire cost of these services. You must contribute to the payment of your own medical bills.

Medicare Part B does not cover some medical services including:

  • Dental care
  • Vision care
  • Hearing care
  • People who help you eat, bathe or dress (custodial care)
  • Medicare treatment you receive outside of the United States

Medicare Part B & Doctors

With Medicare Part B, you can use any qualified medical professional throughout the country who accepts Medicare assignment. Some health care providers choose not to accept Medicare assignment and can charge up to 15% more than the Medicare allowable fees for their services.

There are no geography limitations to your coverage within the United States.

Medicare Part B Eligibility

Everyone who qualifies for Medicare Part A is eligible for Medicare Part B. Some beneficiaries may only have Medicare Part B because they did not work enough quarters to be eligible for premium free Medicare Part A and cannot afford or choose not to pay the Part A premium.

Medicare is an entitlement program. You can’t be refused for Medicare Part B insurance because of your medical history or a pre-existing condition.

Medicare Part B Costs

Your costs for Medicare Part B include:

  • Premium. Everyone pays a fixed monthly fee to have Medicare Part B. The amount you pay is based on your annual income. Those with limited incomes below 135% of the Federal Poverty Level (FPL) may be eligible for assistance with their Part B Premium. You may also pay a late enrollment penalty if you don’t enroll in Medicare Part B when you are first eligible.
  • Deductible. In each calendar year, you must pay for your Medicare-approved medical expenses out of your pocket until you reach your deductible amount. Medicare sets the annual deductible amount every year.
  • Coinsurance. For every medical service, Medicare sets the Medicare approved amount. After you pay your deductible, you are responsible for a percentage of your Medicare-approved medical expenses.

A premium is a fixed amount you pay monthly or quarterly for your Medicare benefits. The other costs (deductibles and coinsurance) occur only when you use your Medicare benefit.

Medicare-Approved Amount

For every medical service, Medicare sets the Medicare-approved amount. This is the maximum amount that Medicare pays for the service.

If your doctor or other care provider accepts Medicare assignment, it means that they can bill you only the Medicare-approved amount for each service. However, if you doctor doesn’t accept Medicare assignment, you will be responsible for paying most of the difference between what the doctor charges and the Medicare-approved amount. These extra costs are called excess charges and can be up to 15% more than the Medicare allowable charges.

There are no limits to your out-of-pocket expenses for your medical care with original Medicare Parts A and B.

Now that you understand original Medicare (Medicare Part A and Medicare Part B), let’s take a close look at Medicare Advantage (Medicare Part C).