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Medicare Insurance: What are the facts?

Medicare Prescription Coverage

Original Medicare Plan

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Medicare Part A

Medicare Part B

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Additional Senior Articles of Interest:

Alzheimer's Disease

Cancer: A Death Sentence for the Elderly?

Depression among the Elderly

General Information and Referral-St. Louis, MO

Health Insurance 101 for Senior Citizens 

Long term care insurance: What is it really?

Medicare: How will it help me?

Nursing Homes: What critical information should I know?

Personal Safety for Grandma and Grandpa

Prescription Medication: You have to get it right

Social Security: Can I get it now?

Senior Housing Options

Senior Care Psychological Consulting

 

 

 

Medicare Part B: What is it exactly? 

Medicare Part B Medical Insurance: 

Medicare Part B medical insurance is insurance for basic outpatient services including doctor's office visits, outpatient hospital mental health care, therapy, diagnostic laboratory services, medical equipment and supplies, ambulance services and emergency care, preventive care, drugs, and blood received as an outpatient. Medicare Part B insurance coverage usually comes into effect after a $100 deductible is paid (2004 dollar figures). After the $100 deductible, coverage is usually reimbursed at the rate of 80% of the covered Medicare approved fee for most services (50% for psychiatric and some other services).  The following are services that are covered and also those that are not covered under Medicare Part B: 

Covered services (after a $100 deductible) under Medicare Part B: 

Doctor's fees.  Most bills from doctors who "accept assignment".

Outpatient hospital mental health care.  Most medical services and supplies, including emergency room visits, one day surgery, and some rehabilitation.  Outpatient mental health care. 

Therapy.  "Medically necessary" outpatient physical, occupational and speech therapy.  No limit if therapy is provided by a hospital outpatient facility. 

Diagnostic and laboratory services. Blood and urine tests, x-rays, scans, EKGs, biopsies, and some screening tests. 

Medical equipment and supplies.  Durable equipment, including hospital beds, wheelchairs, oxygen supplies, and walkers. 

Ambulance service and emergency care.  The cost of ambulance transport (when medically necessary). All emergency care. 

Preventive care.  Mammograms, pap smears, and pelvic exam; pneumonia, hepatitis B, and flu shots; bone mass, colorectal, prostate, heart disease, and glaucoma screening as well as diabetes services. 

Drugs.  Coverage for a few (very few) prescription drugs. 

Blood received as an outpatient.  All but the first 3 pints. 

Services not covered (20% of Medicare's approved fee) under Medicare Part B: 

Doctor's fees.  Charges in excess of "approved fees".  Most routine physical exams.  routine dental care, some chiropractic care and foot care. 

Outpatient hospital and mental health care.  50% of the cost of outpatient mental health services. 

Medical equipment and supplies.  Eyeglasses, hearing aids and dentures. 

Preventive care.  Most other preventive care.  While most of this is covered at 80% of the "approved amount", some care requires no coinsurance payment. 

Drugs.  Most prescription drugs. 

Blood received as an outpatient.  The first 3 pints in each calendar year. 

*These Medicare Part B deductible figures are as of 2004.

Some information from How to Care for Aging Parents by Virginia Morris 

Additional information and web page by Paul Susic M.A. Licensed Psychologist Ph.D. Candidate  Clinical Director- Senior Care Psychological Consulting

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