It’s hard to remember all the various parts and plans involved with Medicare. There are different rules and stipulations, from when you need to enroll to what coverage you receive.
Original Medicare consists of Parts A and B. These are the two parts you enroll in through the Social Security office. Medicare Part A can be thought of as your “room and board” since it covers your inpatient stay at facilities such as a hospital, skilled nursing facility, or hospice.
Medicare Part B provides coverage for your outpatient services. Part B can cover many of the medical services Medicare beneficiaries require, so let’s break down exactly how and what Medicare Part B cover. Visit boomerbenefits.com/new-to-medicare/parts-of-medicare/medicare-part-b/ for more information regarding your medical coverage with Medicare.
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Medicare Part B coverage
Medicare Part B provides beneficiaries coverage with their outpatient medical services. These services include surgery, physical therapy, labs, durable medical equipment, doctor visits, and more. Part B will also provide coverage for preventive care, such as colonoscopies, flu shots, and mammograms. These preventive services are covered 100% under Part B.
What is not covered under Part B?
It’s important to remember that Medicare Part B will not cover all your healthcare needs. Part B will not provide coverage for hospital services covered under Part A. Medicare Part B also does not offer coverage for most prescription you pick up at a pharmacy. You would need to enroll in a Part D plan to have your prescriptions covered.
There is no coverage for routine dental, vision, and hearing services. You would want to look into a standalone plan for these routine services. Lastly, Part B will not cover services and treatments deemed unnecessary by Medicare, such as cosmetic procedures.
It is always best to do your due diligence and consider how and what a medical service would be covered so that you don’t have multiple denied services that are medically necessary to your health.
How much does Medicare pay for Part B services?
Medicare pays for 80% of your Part B services after the annual deductible is satisfied.
What will I pay for Medicare Part B?
Four costs associated with Part B will come out of your pocket. First, you must pay the Part B monthly premium to receive Part B benefits. Most people pay the standard base amount ($170.10 in 2022), but you could pay more depending on your income.
Second, before Medicare Part B cover any service, you must satisfy the Part B deductible ($233 in 2022). Third, after Part B pays its 80%, the remaining 20% must come out of your pocket, with no limit on how much.
Finally, you may have to pay excess charges. These are extra charges a healthcare provider can issue when they accept Medicare but do not accept Medicare’s approved rate for a service. This means a provider can charge up to 15% more than what Medicare pays, and the charge would fall onto you. As long as you receive your medical services from a facility or provider that accepts Medicare Assignment, you will never have to worry about paying excess charges.
Is there an out-of-pocket maximum?
Unfortunately, there is no limit on the remaining 20% Part B doesn’t cover. When it comes to medical services like chemotherapy treatment or expensive surgeries, your out-of-pocket costs can quickly become a bill in your name for tens of thousands of dollars. After Medicare Part B pays its 80%, you will be left with the remaining cost time and time again and expected to pay it all.
Help with Medicare Part B
You certainly do not want to be on the receiving end of a medical bill with 20% of the remaining costs in your name. Expensive surgeries and treatments can quickly add up and cause you to fall into medical debt. You can help avoid these scenarios by enrolling in a Medicare Supplement or Medicare Advantage plan. These plans can help lessen your out-of-pocket spending so you can focus on getting the care you need.