Medicare Part B (Medical Insurance) Focus Flashcards
What Does Part B Cover - Generally?
Medicare Part B (Medical Insurance) helps cover medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services. Medicare may cover some services and tests more often than the timeframes listed if needed to diagnose or treat a condition.
What do I pay for services Part B covers?
What do I pay for services Part B covers?
The list of covered services (in alphabetical order on the following pages)
gives general information about what you pay if you have Original Medicare
and use doctors or other health care providers who accept assignment. You’ll pay more if you use doctors or providers who don’t accept
assignment. If you’re in a Medicare Advantage Plan or have other insurance (like
Medigap, Medicaid, employer, retiree, or union coverage), your copayments,
coinsurance, or deductibles may be different.
Under Original Medicare, if the Part B deductible applies, you must pay all
costs (up to the Medicare-approved amount) until you meet the yearly Part B
deductible. After you meet your deductible, Medicare will pay its share and you
typically pay 20% of the Medicare-approved amount (if the doctor or other health
care provider accepts assignment). There’s no yearly limit on what you pay out of
pocket if you have Original Medicare. There may be limits on expenses you pay
through supplemental coverage you may have, like Medigap, Medicaid, employer,
retiree, or union coverage.
You pay nothing for most covered preventive services if you get the services from
a doctor or other qualified health care provider who accepts assignment. However,
for some preventive services, you may have to pay a deductible, coinsurance, or
both. These costs may also apply if you get a preventive service in the same visit
as a non-preventive service.
Part B- Covered Services: Preventive Services
*Abdominal Aortic aneurysm screenings
*Alcohol misuse screenings & counseling
*Bone mass measurements
*Cardiovascular behavioral therapy
*Cardiovascular disease screenings
*Cervical & vaginal cancer screenings
*Colorectal cancer screening
Counseling to prevent tobacco use & tobacco-caused disease
*Covid-19 Vaccines
*Depression screening
*&Diabetes screenings
*Diabetes self-management training
*Flu shots
*Glaucoma screenings
*Hepatitis B shots
*Hepatitis B Virus infection screenings
*Hepatitis C screenings
*HIV (Human Immunodeficiency Virus) screenings
*Lung cancer screenings
*Mammograms
*Medical nutrition therapy services
*Medicare Diabetes Prevention Program
*Obesity behavioral therapy
*Pneumococcal shots
*Prostate cancer screening
*Sexually transmitted infection (STI) screening &
counseling
*“Welcome to Medicare” preventive visit
*Yearly “Wellness” visit
What Isn’t Covered by part A and part B?
Medicare doesn’t cover everything. If you need certain services Part A or Part B doesn’t cover, you’ll have to pay for them yourself unless:
- You have other coverage (including Medicaid) to cover the costs.
- You’re in a Medicare Advantage Plan or Medicare Cost Plan that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services.
Some of the items and services that Original Medicare doesn’t cover include:
-Most dental care*
-Eye exams (for prescription eyeglasses)
-Dentures
-Long-term care
-Cosmetic surgery
-Massage therapy
-Routine physical exams
-Hearing aids and exams to fit them
-Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
-Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)
NOTE: Original Medicare may pay for some dental services before, or as part of, certain related medical procedures (like before certain cardiac or organ transplant procedures).
Paying For Long-term Care
Medicare and most health insurance, including Medicare Supplement
Insurance (Medigap), don’t pay for long-term care. This type of care
(sometimes called “long-term services and supports”) includes medical and
non-medical care for people who have a chronic illness or disability. This
includes personal care assistance, like help with everyday activities, including
dressing, bathing and using the bathroom. Long-term care may also include
home-delivered meals, adult day health care, home and community-based
services and others. You may be eligible for this care through Medicaid, or
you can choose to buy private long-term care insurance.
You can get long-term care at home, in the community, in an assisted living
facility, or in a nursing home. It’s important to start planning for long-term care now to maintain your independence and to make sure you get the
care you may need, in the setting you want, now and in the future.
