|
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
|