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What Medicare Part B covers

Because many people are confused as to what each part of Medicare covers, in this post we will go over what Medicare Part B covers.  Understanding what Medicare Part B covers and doesn’t cover is crucial for individuals who rely on this program for their healthcare needs.  Although Part B provides extensive coverage for various essential medical services, it is important to consider additional coverage options.  These options help provide comprehensive healthcare coverage access to members for services not 100% covered by original Medicare plan.

Medicare Part B Covers:

1. Part B provides coverage for a wide array of services provided by your doctor.  The appointments can include office visits, consultations & preventative services as well as screenings for various conditions.
2. If you require any outpatient care, Part B will cover it.  Outpatient care may include some services you receive at the hospital as well as various other healthcare facilities.
3. Preventive services are a very important part of Part B coverage.  Preventive care, includes screenings for cancer, cardiovascular diseases, and diabetes, among others. These screenings are important to have in order to detect health issues early and promote overall wellness.
4. It pays for Medical Supplies when they are medically necessary.  Supplies include things such as; blood sugar monitors, lancets, and test strips for diabetics as well as durable medical equipment such as wheel chairs, walkers or hospital beds when it is specified as medically necessary.
5. Some Home Health Services are covered by Part B.  As previously stated, Part B covers specific medically necessary services.  If you require the care of a home health agency under certain circumstances, it is covered.

Click here for a list of covered DME 

Medicare Part B Doesn’t Cover:

1. Long-Term Care is not covered by Medicare Part B.  This includes any custodial care you receive in a nursing home or assisted living facility.
2. If you require routine dental care, such as check-ups, cleanings, fillings, and dentures, they are not covered by Medicare Part B.
3. Routine care for vision is also not covered.  Routine vision care includes, eye exams for prescribing glasses. Although in specific cases where you require treatment for eye disease or an injury, you will be covered.
4. The cost of hearing aids or exams is also not covered by Medicare Part B.
5. Although some Medicare Advantage plans may offer members coverage for acupuncture services, original Medicare including Part B does not cover this treatment option.
6. This one is not going to be a surprise; procedures considered solely cosmetic, such as facelifts or other elective surgeries, aren’t covered by Medicare Part B.

Some things to remember:

Part B does not cover 100% of your approved medical costs.  In most cases, it covers about 80% of your cost after your meet your annual deductible.

This leaves about 20% of the cost for you to pay.  That is why many beneficiaries opt for supplemental insurance to help cover the gaps in their healthcare coverage needs. Both Medigap and Medicare Advantage plans are popular options that can provide additional coverage to beneficiaries.

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Understanding Medicare Supplements: The Basics of Medigap

Medicare covers many health essentials for citizens sixty-five and older but it does not cover everything. Particularly for those with more complex medical histories (or futures), Original Medicare (Parts A and B) is often not enough as they move into their golden years of retirement. This is where understanding Medicare Supplements, or Medigap insurance policies come into play.

What is it?

Medigap is essentially extra insurance. Beneficiaries can buy extra insurance policies from private carriers to help pay their share of the out-of-pocket expenses that come with Original Medicare. Original Medicare is funded by the federal government.   The federal government also contracts with private carriers to ensure that their Medigap policies are safe, uniform, and sufficient. Beneficiaries must have Original Medicare in order to buy a Medigap policy. This means they must sign up for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to be eligible to purchase Medigap.

As previously mentioned, the insurance carriers that provide Medigap policies are contracted with the United States government. This means that the carriers must meet certain guidelines in order to keep their contract each year and continue to sell these policies. All Medigap policies are standardized, meaning that they all cover the same basic health benefits regardless of which company they were purchased from or which state the beneficiary lives in. There are ten different types of Medigap policy, and they are distinguished by letters (A, B, C, etc.). Price is the only difference between carriers’ plans of the same letter. This means that plans with the same letter offer the same coverage regardless of carrier. It is important to note, however, that in Massachusetts, Minnesota, and Wisconsin, the plans are standardized in a different way. Despite this, every Medigap policy must follow state and federal laws to protect their beneficiaries.

What does it cover?

The benefits of each Medigap plan differ (again, usually by letter, or tier), but they are all designed to do one thing: help cover the beneficiary’s share of costs from Medicare Parts A and B. This means Medigap policies can help cover co-payments, coinsurance, and deductibles. Some Medigap policies can cover services that Original Medicare doesn’t cover, like emergency medical care outside of the United States.

What’s not covered?

Medigap can’t cover everything that Medicare Parts A and B doesn’t. Some of the services that are not covered under Medigap policies are long-term care, vision or dental care, hearing aids, eyeglasses, and private nursing. Medigap plans that were sold after 2005 do not include prescription drug coverage, and beneficiaries can opt in to Medicare Part D for that kind of coverage.

Understanding Medicare Supplements – Agent Resources

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Applying for Medicare in Connecticut

This post will try and give you some help when you are applying for Medicare in Connecticut.  This can be overwhelming for some people.  We want to make it easy for you.  If you are 65 years old, or are under 65 and qualify for Medicare because of a disability or other special circumstance, you are eligible for Medicare.  (Note:  You must be a US citizen or a legal resident for at least 5 consecutive years to be eligible for Medicare.)

Apply for Medicare can be done online by CLICKING HERE.  You can also enroll by phone at 1-800-MEDICARE.  Or, you can enroll in person at your local social security office.  You can call 1-800-772-1213 for help locating your local social security office.

Click here for more details regarding choosing a Medicare plan in CT.

Medicare Part B Coverage

Medicare Part B coverage is medical insurance.  Part B covers doctor visits.  It also covers well visits.  Coverage for medically necessary services and supplies is provided. This coverage includes any service or supply that you require for either diagnosis and or treatment of a medical condition. Part B also covers outpatient services.  Covered services include those provided by either a hospital, doctor’s office, clinic or other health care facility.

Medicare Part B also covers many preventive services to prevent illness or detect them at an early stage.  Together,  Parts A and Part B are known as Original Medicare.

Medicare Part B benefits

Medical services and supplies covered by Medicare Part B include (but may not be limited to):

• Doctor’s visits,
• Urgent care visits,
• Laboratory tests,
• X-rays,
• Emergency ambulance services,
• Mental health services, and
• Durable medical equipment.
• Preventive services, such as pap tests, flu shots, and screenings.
• Rehabilitative services, including physical therapy, occupational therapy, as well as speech-language pathology services.

Part B has a monthly premium associated with it.  The monthly premium is $104.90 in 2016.  If you get either Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.   Note:   If you did no take Part B when you were first eligible, the cost of Part B will go up 10% for each full 12-month period that you  could have had Part B but didn’t sign up for it, except in special cases. You will have to pay this penalty as long as you have Part B.

Click here to learn how and when to enroll in Medicare.

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Original Medicare Enrollment

Original Medicare Enrollment in parts A and B is automatic for those drawing Social Security.   Those people who are not that are not will need to enroll.

If you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A .  If you are under 65 and you receive Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

You will need to sign up for Medicare part B, if  you are not receiving retirement benefits before age 65 or  if you qualify for Medicare through disability. Please note, you can sign up during your Initial Enrollment Period (IEP). This is the seven-month enrollment period that begins three months before you turn 65.  This enrollment period includes the month you turn 65, and ends three months later.

Click here to visit the Medicare.gov site to learn details.

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Still have questions?  We are Medicare specialists.  Please call if you have questions or need help navigating the Medicare enrollment process.  You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com.

We are a full-service brokerage and offer clients not only guidance with Medicare, but all health plan needs.  We offer dental insurance, both long and short term care policies.  Crowe and Asscoiates can help with estate planning by offering several types of life insurance as well as investment opportunities.

When someone first becomes eligible for Medicare, they have the choice to sign up for part B.  Part B of Medicare covers physician and outpatient services at 80% after a $144 deductible.   Part B doe have a cost which is $104.90 a month. (deducted out of your social security check or billed quarterly)

Should everyone sign up for part B?  The answer is no.  Anyone that 65 or older and actively working may get stronger coverage from their employer.  If they are actively at work, they do not need to sign up for part B.   They can wait until they retire and sign up then. There will not be a penalty because they are actively at work. (same goes for someone getting benefits from an actively working spouse)

If you are getting benefits but not actively at work, you will be accumulating a penalty for not taking part B when you are eligible for it. The penalty is 10% of the premium for every year you are eligible but do not elect part B.    This may be a problem if you ever lose your retiree coverage and need to sign up for B down the road.

Most people will automatically  be signed up for Part B of Medicare.  If you are getting Social Security payments, you will be signed up prior to you 65th birthday.  When you get the Medicare Card, it will show that Part A and B are in place.  There are instructions on the card if you decide you do not want part B.

If you’re 65 or older and you aren’t getting Social Security or RRB benefits yet (for instance, because you’re still working), you won’t get Part A and Part B automatically. People of any age diagnosed with ESRD and who meet certain requirements are also eligible for Medicare Part A and Part B, but must sign up for them.

You need to sign up by contacting Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you worked for a railroad, call your local RRB office or 1-877-772-5772 to learn more about signing up.

CMS cheat sheet part B sign up