Medicare Part B - Medical Insurance
Overview
Medicare Part B helps pay for doctors' services, outpatient hospital care, durable medical equipment and some other medical services.
While Medicare Part B is optional, it is usually required before you can purchase additional coverage, for example, prescription drug coverage. There is a monthly premium that most people choose to have deducted directly from their monthly Social Security checks. If you use Medicare Part B services, you have to pay an annual deductible and coinsurance for some services.
Medicare Part B Eligible Services
- Doctor services, including office appointments; hospital, clinic and home visits; and surgery.
- Diagnostic X-rays, laboratory tests, radiation therapy and other procedures that are part of your treatment but are not covered under Medicare Part A.
- Medical supplies and services, including surgical dressings, splints, casts and other devices; oxygen, ventilator-assist devices and durable medical equipment used in your home; prosthetic devices; and portable X-ray services.
- Outpatient diagnostic or treatment services provided by certified hospitals, skilled nursing facilities, home health care facilities or rehabilitation facilities, and ambulance transportation.
- Ambulatory surgical center services, including coverage for services provided in connection with certain procedures performed at a Medicare-certified ambulatory surgical center.
- Comprehensive outpatient rehabilitation services delivered at an outpatient rehabilitation facility, doctor's office, skilled nursing facility, hospital emergency room, or home.
- Visits for home health care when ordered by a doctor and provided by a nurse and/or therapist from a Medicare-certified home health agency.
| Service | In 2012 You Pay | In 2012 Medicare Pays |
|---|---|---|
| Medical Expenses | ||
| Physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment | You pay a $140 annual deductible, then 20% of Medicare-approved charges | Medicare pays 80% |
| Clinical Laboratory Services | ||
| Blood tests for diagnostic services | You pay nothing | Medicare covers 100% |
| Other Benefits Under Medicare | ||
| Benefits for medically necessary emergency care received in a foreign country (except in some parts of Canada and Mexico) | You pay 100% of expenses | Medicare pays nothing |
| Preventive Services | You pay for some services | Medicare pays for some services. See preventive services chart |
| Outpatient Prescription Drugs | Costs will vary based on the Part D plan and benefit level you select | Medicare's portion varies |
Many preventive services are covered by Medicare B*:
| Preventive Care & Screenings | Purpose | Frequency |
|---|---|---|
| Flu vaccine | Protects against influenza virus | Annually during flu season |
| Pneumonia vaccine | Protects against pneumococcal pneumonia | Needed only once |
| Cardiovascular health | Checks cholesterol, lipids and triglycerides to determine level of heart disease risk | Once every 5 years |
| Colorectal cancer | Screens for colon cancer | Ask your doctor |
| Welcome to Medicare Physical Exam | One-time review of health history | Once during first 6 months of Part B enrollment |
| Diabetes | Test blood sugar | Ask your doctor |
| Mammogram | Screens for breast cancer | Annually for women over 40 |
| Pap test and Pelvic exam | Screens for cervical and vaginal cancers | Once every 24 months, or every 12 months for women at high risk |
| Prostate Specific Antigen (PSA) an digital rectal exam | Screens for prostate cancer | Once every 12 months for men over 50 |
*This list is not comprehensive
Medicare Part B Eligibility
- You are eligible for Medicare Part B coverage if you or your spouse paid into Social Security for at least 10 years while employed, and you are a citizen or permanent resident of the United States.
- With Medicare Part B, there is a monthly premium, a deductible and coinsurance.
Medicare Part B Enrollment
There are three opportunities to sign up for Medicare Part B:
Initial Enrollment Period for
Medicare Part B
- During the Medicare Part B initial enrollment period, you can enroll three months prior to, during the month of, or three months after your 65th birthday; or after your 24th month of receiving cash disability benefits.
- If you want to decline Medicare Part B enrollment during the initial enrollment period, you must return your Medicare Part B notice to Social Security.
- If you do not sign up, a 10 percent penalty may be added to the Medicare Part B premium for each 12-month period you could have had Medicare Part B but didn't sign up for it. The penalty continues for as long as you have Medicare Part B.
Special Enrollment Period for
Medicare Part B
- If you or your spouse has medical coverage through a union or an employer with more than 20 employees, or you had Medicare Part B coverage and dropped it because you went back to work and had group medical coverage, you can use the Part B special enrollment period to enroll.
- The special enrollment period lasts for eight months and begins when your employer or union coverage ends, or when employment ends, whichever is first.
- To use the Part B special enrollment period, contact Social Security four months before you retire or when your employer or union coverage ends and request a form that your employer will need to complete in order to activate your special enrollment. Attach the completed employer form to your Medicare Part B enrollment form and send them to Social Security.
General Enrollment Period for
Medicare Part B
- If you do not enroll in Medicare Part B during the initial or special enrollment periods, you can enroll during the general enrollment period from January 1 through March 31 of each year, with coverage not starting until July 1.
- For each year you are late in enrolling, you may be charged a 10 percent Medicare Part B penalty.
- The amount charged increases annually as Medicare premiums increase and will continue for your lifetime or as long you are on Medicare Part B. (Note: if you continue to work after age 65 and are enrolled in a group health plan through your employer, you may decide to delay enrolling in Part B until you retire.)
Blue Cross and Blue Shield of Texas is not connected with or endorsed by the US Government, the Federal Medicare Program or any other governmental agency.
