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Medicare Part B

from Songer Benefits, Inc.

Medicare Part B: Medical Outpatient Insurance

Part B covers medically necessary services or supplies needed to diagnose or treat your medical condition and meet accepted standards of medical practices. This includes visits to doctors, specialists, and other health care providers who accept Medicare assignments.

Medically necessary services include acupuncture up to 12 visits in 90 days for chronic low back pain; eight additional visits if you show improvement, 20 visits maximum per year

  • ambulance services
  • chiropractic services
  • diagnostic test
  • outpatient hospital
  • clinical lab services
  • diabetes self-management training
  • chemotherapy
  • doctor and other health care provider services
  • telehealth
  • psychotherapy
  • consultations

Part B covers mental health care services, including visits to doctors, specialists, and other health care providers who accept Medicare assignments. It also covers medically necessary services, and supplies stick diagnose or treat your mental health condition.

Mental Healthcare Includes 

Certain prescription drugs aren't usually self-administered like some injections.

  • Medication management
  • family counseling
  • individual and group psychotherapy
  • psychiatric evaluation
  • partial hospitalization
  • testing
  • Welcome to Medicare one time preventative visit
  • yearly Wellness visit

Medicare Part B preventative and screening services to prevent illness or detect it at an early stage. If you receive these services from a health care provider who accepts Medicare assignments, you pay nothing for most of these services.

Preventative and Screening Services Include 

  • Bone mass measurements, density
  • depression screenings
  • hepatitis C screening tests
  • glaucoma test
  • cervical in vaginal cancer screening
  • diabetes self-management training
  • lung cancer screening
  • yearly Wellness visit
  • prostate cancer screening
  • sexually transmitted infection screening and counseling
  • tobacco use cessation counseling
  • colorectal cancer screening
  • hepatitis B shots
  • HIV screening
  • one time welcome to Medicare preventative visit
  • nutrition therapy services

Medicare Part B covers medically necessary durable medical equipment prescribed by a doctor for home care.

Durable medical equipment includes

  • patient lifts
  • continuous passive motion devices
  • Lancet devices and lancets
  • pressure-reducing support services
  • infusion pumps and supplies
  • crotches
  • hospital beds
  • suction pumps
  • walkers
  • wheelchairs and scooters
  • traction equipment
  • oxygen equipment and accessories
  • blood sugar monitors and blood sugar test strips
  • canes

Some items original Medicare does not cover

  • Routine foot care
  • cosmetic surgery
  • medical care while traveling outside the USA
  • routine preventative physical exams
  • routine dental services or dentures
  • routine eye exams for glasses
  • hearing exams for hearing aids
  • outpatient prescription drugs

Your Cost for Medicare Part B 

If you receive Social Security or railroad retirement board benefits, your Medicare Part B monthly premium will be deducted from your benefit check.

If you don't receive Social Security or railroad retirement board benefits, you'll get a Medicare premium bill every three months. You can mail your payment to Medicare, pay it online through your Medicare account, pay it through your bank's online payment system, or use Medicare easy pay to have the premium automatically deducted from your bank account every month.

The income-related monthly adjusted amount would be added to your Part B monthly premium if you modified the adjusted gross income amount that you reported on your income tax return two years ago in 2019 was more than $88,000 for an individual or $176,000 for a joint return.

Late Enrollment Penalty

If you don't enroll in Medicare Part B when you're first eligible for coverage, your monthly premium may go up 10% for each 12-month period in which you could have had Part B but didn't. This is a lifelong late-enrollment Penalty. Every year, you must pay $203 for covered medical outpatient services before your Medicare Part B begins to pay. The annual deductible does not apply to certain preventative services.

Medicare Part B Copayment 

After your deductible is met, you'll usually pay the hospital or Copayment for each service you receive in a hospital outpatient setting. This is in addition to the Part B coinsurance you pay for most doctors' services. Certain preventative services have no copay. Doctors may charge more for outpatient services provided in the hospital if the same services can be provided in their office. Your copay for each service will generally be capped at the part of a hospital deductible of $1484. There is no annual limit on your Part B out-of-pocket costs if you have original Medicare alone.

Medicare Part B Coinsurance 

Part B coinsurance is typically after the deductible is met, this is the amount you'll typically pay for most Medicare-approved doctor services, including most services you get from doctors in the hospital when you're an inpatient: durable medical equipment, outpatient therapy, and Part B drugs such as chemotherapy. Doctors, providers, and suppliers who accept Medicare assignments have agreed to pay directly by Medicare and will accept the Medicare-approved amount as full payment for covered services.