What Is Medicare Part B?

What Is Medicare Part B insurance? Highlights of Part B coverage for services not covered by Part A Hospital insurance. Part B Medicare insurance helps pay primarily for outpatient services and products not covered by Part A hospital coverage. 

Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. It covers doctors visits, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Part A when medically necessary.

What is Medicare Part B - Services Covered
Part B coverage includes:

  • Physician and nursing services provided in the doctor's office
  • Kidney dialysis
  • X-rays, laboratory, and diagnostic tests
  • Pneumonia and influenza vaccinations
  • Blood transfusions
  • Hormonal treatments
  • Outpatient hospital procedures
  • Restricted ambulance service
  • Prescriptions for organ transplant recipients that prevent rejection of organs
  • Chemotherapy

Medication administration is covered under Part B only if it is applied by the physician during an office visit.

What is Medicare Part B - Durable Medical Equipment (DME) Covered
Some of the DME covered by Part B is:

  • Walkers, wheelchairs, and canes
  • Scooters
  • Prosthesis, artificial limbs, and breast prosthesis
  • Eyeglasses following cataract surgery
  • Oxygen

Medicare part B is administered by the Centers for Medicare and Medicaid Services (CMS) which is part of the Department of Health and Human Services (HHS). CMS routinely releases advisories describing coverage criteria and changes. These advisories are called National Coverage Determinations (NCD). They describe limitations of the particular coverage. There are also similar local advisories issued by the regional Medicare contractor called Local Coverage Determinations (LCD).

Enrollment for Part B can be started during a 7-month period beginning 3 months before age 65. If an eligible participant decides not to enroll in Part B and is without other coverage, but changes their mind later, enrollment can be made during the annual General Enrollment Period, January 1 through March 31. Part B benefits will not be effective until July 1 of that year. A late enrollment penalty of 10% of the current Part B premium may be required for each 12-month period the insured could have had Part B coverage, but did not take it. To sign up contact Social Security at 1-800-772-1213 or visit your local Social Security office.

The Medicare Part B deductible (2012) is $140 a year. After the $140 deductible is met, the beneficiary is responsible for 20% of the Medicare approved amount for the services.

In 2012, the standard Medicare Part B premium will be $99.90 which is a $15.50 decrease over the standard 2011 premium of $115.40. These premiums are paid by new enrollees, higher income Medicare beneficiaries, and by Medicaid on behalf of low-income enrollees.

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