When Medicare was introduced in 1965, prescription drugs were not covered. However, in December 2003, Medicare Part D was signed into law to cover the cost of...
Along with Medicare Part A, Part B is the other part of Original Medicare. A recent blog post described Medicare Part A coverage for inpatient care (hospital and skilled nursing), hospice care, and home healthcare.
Medicare Part B covers medically necessary costs for:
Medicare Part B differs from Part A in terms of cost. Most notably, beneficiaries pay a monthly premium cost, whereas most people don't have a Part A premium. In 2022, most people will pay the standard Part B premium amount of $170.10. However, it can be more depending on income. If modified adjusted gross income on IRS tax return from 2 years ago exceeded $91,000, the monthly amount could be anywhere from $238.10 to $578.30.
Part B premiums are deducted from social security benefits. For Medicare beneficiaries not receiving social security, a monthly bill is payable through check, credit card, or other methods.
Other costs such as deductibles, coinsurance, and copayments apply for healthcare services rendered under Part B. For example, the 2022 Part B annual deductible is $233. Once this is paid, coinsurance kicks in at 20%. This means the beneficiary is responsible out-of-pocket for 20% of qualified healthcare costs after the deductible. (Note that some preventative services have a $0 deductible or coinsurance.)
It is important to be aware that there is no annual limit on what a beneficiary pays out of pocket for Original Medicare. However, supplemental coverage like Medigap, Medicaid, or Medicare Advantage may provide caps on the annual amount paid.
If a beneficiary has Original Medicare, the specific costs Medicare covers are detailed in "Medicare Summary Notice" (MSN). This document lists all the services billed to Medicare. It is not a bill. It simply shows what Medicare paid for services, supplies, or equipment.
Medicare Part B covers a wide range of healthcare services and products. However, coverage only applies if the provider accepts "assignment." This means accepting Medicare-approved reimbursement amounts for a service or product as payment-in-full. This aids beneficiaries in the form of lower out-of-pocket costs. Typically, the provider bills Medicare first before billing the beneficiary.
However, not all providers accept assignment for all services covered by Medicare. Some may accept assignment for some services and not others. These providers are considered "non-participating." A possible impact on the beneficiary could be a requirement to pay all fees upfront for Medicare-covered services, followed by applying for Medicare reimbursement.
As mentioned above, a major part of what Part B covers is doctor's fees. The list of services and products covered is extensive. Especially important are preventive services. These services provide a dual benefit in maintaining a higher quality of health for beneficiaries while simultaneously lowering costs for Medicare. Examples of preventive services are:
While Part A covers inpatient care, Part B covers outpatient services. There are differences in costs for outpatient treatment in a hospital versus a doctor's office. Therefore, a beneficiary's coinsurance and copayment amounts may be higher in a hospital outpatient setting.
Mental health needs are covered under Part B outpatient services. Examples are counseling or therapy done in a provider's office or hospital outpatient department with such professionals as:
Like Part A, Medicare Part B covers some home healthcare costs. Examples are:
For Part B, a Medicare-certified home health agency must provide services. Also, a doctor needs to have a face-to-face visit to certify that the beneficiary needs in-home health services.
Medicare Part B will cover medically-necessary durable medical equipment (DME- e.g., wheelchair) and other medical supplies. Part B deductibles and 20% coinsurance apply, assuming that the DME supplier accepts assignment. DME can be either purchased or rented.
Original Medicare does not cover all services or products. Examples are: