Medicare is the federal health insurance program designed to give the elderly and disabled citizens of the United States quality and affordable care. Over 40 million Americans are enrolled. Part A and Part B are the two major components. Understanding Medicare benefits is key for beneficiaries to get the most of their health care.
Definition
Medicare Part B essentially covers all services that do not require an inpatient hospital stay. It is outpatient insurance, and most services must be considered medically necessary in order to be qualified for coverage.
Cost
Part B has many costs associated with it. The most substantial cost of Part B is the monthly premium. According to Medicare Interactive, the 2010 premium was $96.40; however, those with notably high incomes may pay more, and those with very low incomes may qualify for programs that will waive their Part B fee. In addition to the monthly premium, Part B enrollees are also responsible for an annual deductible and a 20 percent coinsurance on most services (45 percent coinsurance on mental health services).
Services
Medicare.gov says that there are two types of services that Part B will cover: medically necessary services and preventive services. Medically necessary services include doctors' visits, home health care, laboratory tests, chiropractor services, mental health services, blood or ambulance services. Enrollees are not eligible to receive these services unless they are medically necessary.
There are some preventive services available under Part B. These include diabetes screenings, services and supplies, nutritional therapy, glaucoma screenings, pap smears, pelvic exams and mammograms, several types of cancer screenings, vaccines and one routine physical. Medicare has very specific guidelines about who can access these services and when they can be accessed. Some services are only accessible every few years, and only if you meet certain criteria, such as belonging to an at-risk population group.
Enrollment
Many people are automatically enrolled into Part B when they become eligible, because they are receiving either Social Security retiree benefits, railroad retiree benefits or Social Security Disability Insurance. Those who are not automatically enrolled can enroll themselves at any Social Security office.
Considerations
Part B is an optional benefit. Due to the high costs, some people decide to opt out of the benefit. However, this may have some negative consequences. Medicare Interactive reports that delaying Part B enrollment will result in the accruement of a premium penalty. If the beneficiary decides to enroll into Medicare at a later date, he will have to pay a substantially higher penalty for as long as he has Medicare.
However, those who are still working may be exempt from the Part B penalty if they have adequate health coverage from a large enough group health plan. If there are more than 20 employees in the group health plan, they will not have a penalty when they decide they want Part B later on, and they will qualify for a Special Enrollment Period once they lose or leave the group health plan.
Tags: group health, group health plan, health plan, medically necessary, Social Security, when they