Monday, May 20, 2024

What Is Covered Under Medicare Part B

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From January 1 To March 31 Each Year

Medicare Explained / Medicare Part B & Medicare Part A (and Supplements)

You can sign up during general enrollment from January 1 to March 31 if:

  • You didnt sign up when you were first eligible.

  • You cancelled Part B without having other insurance but would like to re-enroll.

  • You didnt enroll for Part B within eight months after your employer or union health plan ended or when you stopped working, whichever happened first.

Regardless, if you apply for Part B between January 1 and March 31, your coverage will start on July 1.

Medicare Part B Medical Coverage

What it helps cover:

What it costs:

  • Most 2021 Medicare members must pay a monthly premium of $148.50.
  • If you donât enroll in Medicare Part B as soon as you are eligible, you could be assessed a late enrollment penalty when you do enroll.
  • The penalty could be as high as a 10% increase in your premium for each 12-month period that you were eligible but not enrolled.
  • Your Part B premium could be higher depending on your income.
  • Other Part B costs:

    • There is a $203 annual deductible for Medicare Part B in 2021. After the deductible, youll pay a 20% copay for most doctor services while hospitalized, as well as for DME and outpatient therapy.
    • There is a 20% copay of the Medicare-approved amount for doctor visits to diagnose a mental health condition after the deductible.
    • If you receive these services at a hospital outpatient department or clinic, additional copays or coinsurance amounts may apply.
  • There is a 20% copay of the Medicare-approved amount for outpatient services after the deductible.
  • Does Medicare Cover Dental Services

    If youre wondering whether Medicare offers dental coverage, the answer is, It depends. Dental coverage is limited under Original Medicare, and you wont be covered for most routine dental services. However, routine dental coverage may be available as part of a Medicare Advantage plan. Because Medicare Advantage plans are available through Medicare-contracted private insurance companies, benefits may vary by plan.

    Find affordable Medicare plans in your area

    Heres an overview of how Medicare dental coverage works and the situations where you may be able to get help with dental costs.

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    Alcohol Misuse Screening And Counseling

    Medicare covers one alcohol misuse screening per year for adults with Medicare who use alcohol, but dont meet the medical criteria for alcohol dependency.

    If your primary care doctor determines youre misusing alcohol, you can get up to four brief face-to-face counseling sessions per year . A qualified primary care doctor or other practitioner must provide the counseling in a primary care setting . You pay nothing if the qualified primary care doctor or other primary care practitioner accepts assignment.

    Who Is Eligible For Medicare Part B

    Medicare Part B  Medical Insurance

    To apply for Medicare Part B, there are fewer requirements than Medicare Part A. You are eligible to sign up for Medicare Part B if you are a U.S. citizen and are 65 years of age or older. You may also be automatically enrolled in Medicare Part B through disability.

    While Medicare Part A is available premium-free, Medicare Part B is available with a monthly premium. Most people pay a monthly premium for Medicare Part B of $104.90 and have a deductible of $147 per year. Find out more about Medicare Part B costs.

    If you do not apply for Medicare Part B when you are first eligible, you may face a late enrollment penalty when you do enroll. After your Initial Enrollment Period ends, for each 12-month period that you could have had Part B but did not sign up for coverage, your monthly premium for Medicare Part B may increase by 10%. For example: Your Initial Enrollment Period ended on August 31, 2012. You waited to sign up for Part B during the General Enrollment Period in March 2015. Your Part B penalty is 20%, which you will have to pay for as long as you have Part B.

    Although you may be eligible for Medicare Part A and Medicare Part B, you may prefer additional coverage through a Medicare Supplement Plan, Prescription Drug Plan, or a comprehensive Medicare plan, also known as Medicare Advantage, to manage your medical care costs.

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    Are Dentures Covered Under Medicare

    No, Original Medicare does not cover dentures or routine dental care, except when part of an emergency inpatient procedure. This means that you are responsible for 100 percent of the cost of dentures if you have Original Medicare.

    Many Medicare Advantage plans, however, may cover dentures and other routine dental procedures.

    Doctor And Other Health Care Provider Services

    Medicare covers medically necessary doctor services and covered preventive services. Medicare also covers services provided by other health care providers, like physician assistants, nurse practitioners, social workers, physical therapists, and psychologists. Except for certain preventive services , you pay 20% of the Medicare-approved amount, and the Part B deductible applies.

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    When Can I Apply For Medicare Part B

    There are four enrollment periods during which you may choose Medicare coverage.

    Initial Enrollment Period: You can sign up for Medicare during a seven-month Initial Enrollment Period . This period includes the three months before your 65th birthday, the month of your birthday, and the three months after you turn 65.

    General Enrollment Period: If you miss your Initial Enrollment Period for Medicare coverage, you may sign up for Medicare between January 1 and March 31 each year during a General Enrollment Period. You could face a late penalty for missing your initial opportunity to enroll in Medicare, but you will be able to apply for coverage during this time.

    Annual Election Period: Each year from October 15 to December 7, you may sign up for Medicare coverage or prescription drug coverage to begin January 1 of the following year. Additionally, changes may be made to any existing Medicare plan during this time.

    Special Election Period: If you experience a loss of health insurance coverage that was previously covered by your job or union health insurance, you may qualify for a Medicare special enrollment period. This eligibility period will be determined based on the date you lost coverage.

    If you fall within one of the four enrollment periods for Medicare coverage, compare Medicare plans with Blue Cross and Blue Shield of Alabama today.

    Why Should I Continue Undergoing Bi

    Medicare Part B & Medicare Part A (Explained)

    Preventive care is crucial to your oral health and your overall well-being. It is especially important for our oldest patients, who are at higher risk for developing gum disease and oral cancer. Often, conditions such as a dental infection or minor cavities do not present with any signs or symptoms. However, a dental professional can identify these issues early on and perform appropriate treatment before you require more costly and extensive restorative procedures. Timely treatment can not only save you time and money but protect your dental function, and in turn, your quality of life.

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    What Infusion Drugs Are Covered By Medicare Part B

    Infusion drugs are those that are administered intravenously through a needle or catheter. To be covered by Medicare Part B, the drugs must be non-oral or biological, administered through an IV or applied under the skin for a period of at least 15 minutes. The drugs must be considered reasonable and necessary and not self-administered.

    Some common infusion drugs that may be covered by Medicare Part B include:

    • Rituxan
    • Cimzia
    • Prolia

    If you would like to check Medicare Part B coverage of a specific drug, call 1-800-MEDICARE and speak to a representative concerning your medications and the coverage requirements surrounding it.

    What Is Medicare Part A

    Medicare Part A is sometimes referred to as hospital insurance. As the name implies, this is the Medicare plan that covers hospital stays and inpatient treatment. For treatment to be covered by Medicare Part A, it must be deemed medically necessary. This means a doctor has agreed that the treatment is required to prevent or treat a condition or illness.

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    Some Services Not Covered By Part B

    • Routine vision, routine hearing screening exams, routine chiropractic care, prescription drugs, first 3 pints of blood
    • Chiropractic services
    • Cosmetic surgery
    • Dental care and dentures
    • Eye care , eye refractions, and most eyeglasses
    • Routine foot care
    • Health care while traveling outside the United States, except in limited cases
    • Hearing aids and exams for the purpose of fitting a hearing aid
    • Hearing tests that haven’t been ordered by a doctor
    • Long-term care
    • Orthopedic shoes
    • Prescription drugs
    • Syringes or insulin, unless the insulin is used with an insulin pump

    Who Is Covered By Medicare What Services Are Covered Quizlet

    Medicare Part B Outpatient Coverage in 2020

    The program covers all those who are eligible regardless of their health status, medical conditions, or incomes. Basic health services, including hospital stays, physician visits, and prescription drugs. What are some gaps in Medicare coverage? Long-term care services, vision services, dental care, and hearing aids.

    Read Also: Where Do You Sign Up For Medicare

    Is There A Limit On Out

    There is no out-of-pocket spending limit with Original Medicare .

    Medicare Advantage plans, however, do feature an annual out-of-pocket spending limit for covered Medicare expenses.

    While each Medicare Advantage plan carrier is free to set their own out-of-pocket spending limit, by law it must be no greater than $7,550 in 2022. Some plans may set lower maximum out-of-pocket limits.

    Medicare Advantage plans are offered by private insurance companies. When you enroll in a Medicare Advantage plan, it replaces your Original Medicare coverage and offers the same benefits that you get from Medicare Part A and Part B.

    Most Medicare Advantage plans provide prescription drug coverage, which is not typically covered by Original Medicare.

    Some Part C plans also offer other benefits that Original Medicare doesnt cover, which may include:

    • Routine hearing, dental and vision coverage
    • Non-emergency transportation to approved locations
    • Over-the-counter medication allowances
    • Health and wellness programs, such as SilverSneakers

    Depending on where you live, you may be able to find $0 premium Medicare Advantage plans.

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    When Should I Apply For Medicare Part B

    Initial Enrollment Period this is a 7-month period that includes:

    • the three months before the month you turn 65
    • the month of your 65th birthday
    • the three months after the month you turn 65.

    Special Enrollment Period if you or a spouse are still working, you may sign up anytime while you have group health coverage or during the 8-month period that begins the month after employment or coverage ends, whichever occurs first.

    General Enrollment Periodbetween each year. Your coverage will start July 1st of that year. The cost of Medicare Part B will go up 10% for each 12-month period that you could have had Medicare Part B but didnt take it . You will have to pay this late enrollment penalty as long as you have Medicare Part B.

    Medicare Part B comes with part A, but you can elect not to receive it if, e.g., you decide to continue working. It is recommended that you speak with your HR department if you or your spouse are currently and enrolled in a group insurance plan. Note to Reader: This is not recommended unless you are certain you have other Creditable Coverage

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    When Can You Enroll In Medicare Part B

    You can sign up for Medicare Part B during the 7-month period that begins 3 months before your 65th birthday and 3 three months after that birthday.

    If you have ALS, you may enroll in Medicare as soon as your Social Security disability insurance goes into effect.

    If you have ESRD, you can enroll for Medicare starting on the first day of your fourth month of dialysis. If you do home dialysis, you dont have to wait 4 months and can apply immediately.

    You may also apply immediately for Medicare if youre hospitalized for a kidney transplant.

    Outpatient Care And Laboratory Testing

    Medicare Part B and FEHB

    Medicare medical insurance covers outpatient hospital treatment, such as emergency room or clinic charges, X-rays, injections that are not self-administered, and laboratory work and diagnostic tests. Lab work and tests can be done at the hospital lab or at an independent laboratory facility, as long as that lab is approved by Medicare.

    Beware: Medicare pays only a limited amount of outpatient hospital and clinic bills. Unlike most other kinds of services, Medicare places no limits on how much the hospital or clinic can charge for outpatient services over and above what Medicare pays.

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    How Much Do Dentures Cost Under Medicare

    Dentures can cost anywhere from a few hundred to a few thousand dollars, depending on the type of dentures you get.1

    The amount that you pay for dentures may depend on the level of coverage provided by your Medicare Advantage plan.

    First, you may have a monthly premium in order to belong to the plan. In 2021, the average premium for a Medicare Advantage plan with prescription drug coverage is $33.57 per month .2 In fact, $0 premium Medicare Advantage plans may be available where you live.

    Your Medicare Advantage plan may also have a deductible, which is the amount of money you must pay for covered services and items before your benefits kick in.

    Lastly, you may have some coinsurance or copayment amount for your dentures, which is your portion of the cost-sharing after you meet your deductible.

    When you consider potential cost of dentures, you may find that enrolling in a Medicare Advantage plan that includes dental benefits could help you save you money in the long run.

    Direct Member Reimbursement Allowance

    With Aetna MA plans that include a direct member reimbursement allowance, members are given a set amount of money to spend each year on dental care. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna® for reimbursement.

    With a direct member reimbursement allowance, youre given a set amount of money to spend each year on dental care.

    You can see any licensed dental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs .

    One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance.

    Direct member reimbursement allowance: How to get reimbursed for dental care

  • When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided.
  • Print and fill out the reimbursement form. Or log in to your member account to submit the form online.
  • Send the form with the receipt to the claims address found on your member ID card. Be sure to make copies of all of your paperwork. If youre submitting your form online, be sure to attach your receipt to your submission.
  • Claims must be submitted within 365 days of the date you received the service.
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    Congress Should Expand Medicares Dental Vision And Hearing Benefits

    Analysts have identified a range of options for expanding dental, hearing, and vision coverage under Medicare. The most straightforward and comprehensive approach for beneficiaries would be to add these benefits to Part B of Medicare. Another would create a new voluntary benefit under a separate part of Medicare, similar to the prescription drug benefit under Part D. Each of these approaches would require decisions about covered benefits, cost sharing, premiums, payment rates, provider participation, and assistance for low-income beneficiaries. Other more limited options include broadening the coverage of medically necessary dental care, testing alternative models of coverage under the CMS demonstration authority, and offering discount cards or other cash assistance to help cover the cost of services.

    The hearing benefit in H.R. 3 would cover aural rehabilitation services and one set of hearing aids every five years for people with profound or severe hearing loss starting in 2023. It would also designate audiologists as practitioners under Medicare. The vision benefit would cover routine eye examinations and contact lens fitting services, but no more than once every two years, starting in 2023. It would cover eyeglasses and contact lenses starting in 2024, up to $85 for frames and $85 for eyeglass lenses once every two years, and up to $85 for a two-year supply of contact lenses.

    Licensing All Qualified Providers Would Expand Access to Needed Dental Care


    Drugs That Are Used With Durable Medical Equipment

    Medicare Part B Overview

    Durable medical equipment includes things like walkers, wheelchairs and other supplies used in the home and are covered by Medicare Part B. Durable medical equipment can also include things like nebulizers, infusion pumps and other equipment that pair with medication.

    Medicare Part B covers drugs that are infused through durable medical equipment. That can include insulin when the use of an insulin pump is determined to be medically necessary.

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    Does Medicare Cover Shingles Shots

    Proper diagnosing and treatment for shingles must first begin with a doctors visit. Part B pays for 80% of the doctors fee-for-service. Although, you must first have met your annual deductible amount.

    Most Supplement plans cover your medical bills and filling in your gaps. But, once your doctor diagnoses you with the Shingles, medication, and vaccines are essential for treatment.

    Chronic Care Management Services

    If you have 2 or more chronic conditions that are expected to last at least a year, Medicare may pay for a health care providers help to manage those conditions. This includes a comprehensive care plan that lists your health problems and goals, other health care providers, medications, community services you have and need, and other information about your health. It also explains the care you need and how your care will be coordinated. A chronic condition could be arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, and other conditions. Your health care provider will ask you to sign an agreement to provide this service. If you agree, he or she will prepare the care plan, help you with medication management, provide 24/7 access for urgent care needs, give you support when you go from one health care setting to another, review your medicines and how you take them, and help you with other chronic care needs. Theres a monthly fee, and the Part B deductible and coinsurance apply.

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