Medicare Part B | Outpatient Services| Medigap Insurance

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Medicare Part B
Like Medicare Part A, Medicare Part B is a government sponsored medical insurance plan that helps cover medical expenses related to doctor’s services, also known as outpatient expenses. Many Americans will automatically receive Medicare Part A but Medicare Part B is optional coverage that is available by paying a monthly premium. If you wish to enroll in additional coverage participation in Medicare Part B is required. Including Medicare programs such as:
Medigap Plans (Medicare Supplemental Insurance Plans)
Prescription drug coverage (Medicare Part D/Medigap Plan D)
Medicare Advantage Plans

Costs Associated with Medicare Part B
When participants enroll in Medicare Part B they are required to pay a premium monthly. This is a standard premium that most people will be required to pay. Enrollees that have an adjusted gross income during the previous 2 years that is above the threshold set my Medicare and is reported to the IRS may be required to pay extra. This premium is known as an income related Monthly Adjustment Amount (IRMAA) and is the extra charge added to the Medicare Part B premium.
How much does Medicare Part B cost?
The premium that Medicare Part B participants is set at $134 each month for 2017 Medicare enrollees for 2017 while the deductible is set at $183.00. If participants choose to enroll in Medicare Part B after their enrollment period they will be assessed a penalty.
Medicare part B Premiums by Income
If your yearly income in 2015 (for what you pay in 2017) wasFile individual tax returnFile joint tax returnFile married & separate tax returnYou pay each month (in 2017)$85,000 or less$170,000 or less$85,000 or less$134above $85,000 up to $107,000above $170,000 up to $214,000Not applicable$187.50above $107,000 up to $160,000above $214,000 up to $320,000Not applicable$267.90above $160,000 up to $214,000above $320,000 up to $428,000above $85,000 and up to $129,000$348.30above $214,000above $428,000above $129,000$428.60What does Medicare Part B Cover?
Coverage under Medicare covers services that are considered medically necessary in order to provide treatment for a condition or disease. This includes:
Lab tests

Participants in Medicare Advantage and Medigap Plans have a different set of rules to follow. This coverage that they offer must be the same as Original Medicare however; certain services may only be covered in certain settings or for patients with certain conditions. In general coverage under Medicare Part B includes:
Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health

    Partial hospitalization

    Getting a second opinion before surgery
    Limited outpatient prescription drugs

    Medicare Part B covers two types of services
    Medically necessary services: Services or supplies that are needed to diagnosis or treat a condition and meet standard accepted medical practices
    Preventative services: Any heath care need that prevents illness, such as the flu, or that detects it at an early stage, when treatment is deemed necessary

    Does Medicare Part B Cover what you need?
    In order to determine if the care you need is going to be covered under Medicare Part B you can do one of two things.
    The most effective way is to talk with the health care provider about why the service or supplies are needed and ask Medicare if they will be covered. You will need to sign a waiver that states you may be required to pay out of pocket if expenses are not covered.
    Check out your Medicare coverage online. There is a government sponsored website that can be found at that will give you detailed information into your coverage.
    With Medicare Part B participants pay nothing out of pocket for most preventive services when they come from a health care provider that accepts Medicare.
    Medicare Coverage is based on 3 Main Factors
    Federal and state laws
    National coverage decisions made by Medicare
    Local coverage decisions made by companies in each state that process Medicare claims. These companies will help decide whether something is medically necessary and should be covered.

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Author: Victoria