What Is Medicare Part B Coverage?
In the United States, elderly and disabled citizens have access to Medicare, a federal health insurance program. Medicare offers quality and affordable coverage to over 40 million Americans. Medicare is considered notorious for its many parts and complicated structure, and Part B is just one of the several components. Understanding the different parts of Medicare can help consumers get the most out of their coverage.
Definition
Medicare Part B is outpatient medical insurance. It essentially covers all that would not fall under Part A, which is inpatient hospital insurance. In order to qualify for coverage, services should be medically necessary in most instances.
Services Covered
Medicare separates Part B coverage into two categories: medically necessary services and preventive services. Medically necessary services make up the majority of Part B services, including any visits to the doctor, laboratory tests, x-rays, home health care, mental health services and more. It is essentially anything that is covered by Medicare that is required to sustain the health of the beneficiary that does not require an overnight hospital stay. Part B also offers limited preventive services. Access to these services is contingent upon whether the beneficiary meets certain guidelines and criteria, such as belonging to an at-risk population. Some of the services offered include diabetes services, glaucoma screenings, cancer screenings, female reproductive health services, vaccines and one annual physical.
Costs
The primary cost associated with Part B is the monthly premium, which Medicare Interactive reports typically costs between $96.40 and $110.50 as of 2010. The price may vary because those with higher incomes may pay more while those with lower incomes often qualify for programs which waive the Part B premium. Furthermore, Part B beneficiaries should also expect to pay a 20 percent coinsurance for most services and an annual deductible of $155.
Considerations
Many beneficiaries decide not to sign up for the Part B benefit. This may cause some problems in the future for these beneficiaries. Medicare Interactive reports that delaying Part B enrollment may result in a premium penalty if the beneficiary ever decides to take Part B again. This penalty will mean a higher Part B premium for as long as he has Medicare. Those who are actively working may be exempt from the Part B penalty if they have adequate health coverage. Medicare considers coverage from a large health plan with 20 or more employees adequate. If this is the case, they will not have a penalty if they decide they want Part B at a later date.
Enrollment
During a qualified enrollment period, beneficiaries may sign up for Part B coverage by visiting their local Social Security office. Qualified enrollment periods include the initial enrollment period (three months before someone first becomes eligible, the month of and the three months following), the open enrollment period (January 1 to March 31 each year) and the annual coordinated election period (November 15 to December 31 each year). However, many beneficiaries do not need to actively enroll as they are automatically enrolled once they become eligible. This includes those receiving Social Security retiree benefits, railroad retiree benefits and Social Security Disability Insurance.
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