Medicare Part B Explained - Medicare Consumer - Medicare Consumer

Medicare Part B Explained

Medicare Part B covers services such as lab tests, surgeries, and doctor visits, as well as supplies like wheelchairs and walkers that are considered to be medically necessary for treating diseases or conditions.

This part of Medicare is optional, and it requires a monthly premium. In 2015, most people pay $104.90 per month for their Medicare Part B premium. However, the premium could be higher, if your modified adjusted gross income on your IRS tax return from two years prior is more than a certain amount.

For example, if your 2013 adjusted gross income was above a certain amount based on the chart below, and based on how you file your annual IRS tax return, you may be required to pay a higher amount for your Medicare Part B premium.

File individual tax return File joint tax return File married and separate tax return Your monthly Medicare
Part B premium (in 2014)
$85,000 or less $170,000 or less $85,000 or less $104.90
Above $85,000 up to $107,000 Above $170,000 up to $214,000 Not applicable $146.90
Above $107,000 up to $160,000 Above $214,000 up to $320,000 Not applicable $209.80
Above $160,000 up to $214,000 Above $320,000 up to $428,000 Above $85,000 and up to $129,000 $272.70
Above $214,000 Above $428,000 Above $129,000 $335.70

Source: Medicare.gov

Your Medicare Part B premium may also be higher if you did not sign up for Part B when you first became eligible. For example, if you do not sign up for Medicare Part B when you are first eligible, the premium will go up 10% for each full 12-month period that you could have had this coverage, but didn’t sign up for it. If you later decide to sign up for Medicare Part B, you may have to pay this higher premium amount for as long as you have it. You also pay a deductible each year before Medicare Part B will pay for services.

This part of Medicare primarily covers two types of services. These include medically necessary services, and preventive services. Some of the services that Medicare Part B covers include:

  • Clinical Research – Medicare covers clinical research studies, which test different types of medical procedures and / or drugs. For example, this may include determining how well a certain cancer drug works. These types of studies can help medical professionals and researchers to see whether a new treatment works, and to know if it is safe. Medicare Part A (Hospital Insurance) and / or Medicare Part B (Medical Insurance) cover certain costs, such as office visits and tests, in certain qualifying clinical research studies. You may be required to pay 20% of the Medicare-approved amount, depending on the treatment that you get. The Part B deductible may also apply.
  • Ambulance Services – This part of Medicare covers emergency ground ambulance transportation when you need to be transported to a hospital, a critical access hospital, or a skilled nursing facility. Medicare helps to pay for this type of transportation when you have had a sudden medical emergency, and your health is in serious danger because you cannot be safely transported by other means such as by car or taxi.
  • Durable Medical Equipment – Medicare Part B also covers durable medical equipment that is prescribed by your doctor for use in your home. (Only your doctor can prescribe this equipment). Durable medical equipment is that which is considered to be long-lasting, is used for a medical reason, is not usually useful to someone who is not sick or injured, and is used in your home.
  • Mental Health – Inpatient, outpatient, and partial hospitalization for mental health may be covered by Medicare. While Part A of Medicare covers the services that require you to be admitted as an inpatient, Medicare Part B will cover mental health services and visits from health professionals such as psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physicians. However, Medicare will only cover these visits – often called counseling or therapy – when they are provided by a health care provider who accepts Medicare assignment.
  • Limited Outpatient Prescription Drugs – You may also be covered for a limited number of outpatient prescription drugs under certain conditions. Generally, drugs that are covered under Part B of Medicare are those that you would not typically give to yourself, such as those that you would obtain at a doctor’s office or a hospital outpatient setting. Examples can include drugs that are used with an item of durable medical equipment such as those that are infused through an item of durable medical equipment like an infusion pump or those that are given by a nebulizer.
  • Getting a Second Opinion Before Surgery –  A second opinion is when a doctor other than your regular doctor gives you his or her view about your health issue and how to treat it. It can assist you in making a more informed decision about your care. Medicare Part B covers a second opinion in some cases for surgery that is not an emergency. It may also help to pay for a third opinion if the first and second opinions are different.

Note: All above services may require the use of coinsurance and/or deductibles.

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