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In the first few years of school, we learn the ABCs. Then, we learn what they can do for us. They can teach us about the world. They can entertain us. They can frustrate us.
The Medicare alphabet is similar. We have to learn the ABCDs and find out what they can do for us. They will help keep us healthy. Maybe they won’t entertain us, but they can, without a doubt, frustrate us. They can be confusing and, worse, can change over time.
We are here to help. We previously provided you with insights about Part A, which is known as Hospital Insurance. Now, we will move on to Part B, known as Medical Insurance. Part A is free, unless you are not eligible for Medicare. Part B costs money.
The keyword to remember about A and B is “approved.” Only approved doctors, services and equipment will be covered.
It is important for you to know what you get under Part B and what you will pay. This blog talks about what you get. Next week, we will cover what you pay.
Part B basically is Medical Insurance. This means you can receive medically-necessary services from a doctor anywhere in the U.S. – in a doctor’s office, a hospital, a home visit or a long-term care facility. That is:
IF the doctor is approved and accepts Medicare patients
IF the facility is approved
IF the services you need are approved
Being approved is also known as being “in network.”
What you get – coverage under Part B.
We recommend that you check with your doctor before scheduling any service to make sure it will be covered. It just takes you a phone call and will save a lot of heartache later if it’s not covered. Also, just because Medicare is a national program doesn’t mean all services are covered equally. There may be differences from state to state.
This is important: keep track of time between services. Many services, like wellness checks or mammograms are covered once in a 12-month period. If you have had a mammorgraml in January of 2017, do not get another one in December of 2017. It will not be covered. You will be responsible for the entire amount. Wait until a full year has gone by.
When you choose a doctor, be sure that he or she is in network, accepts Medicare, and accepts “assignment.” This means they have agreed to accept the Medicare approved amount for their services as full payment. If they do not accept assignment, you will be responsible for the difference between the approved amount and the fee charged.
If you are in the hospital, Part A covers your room, meals and nursing care (after your deductible). Part B takes over beyond that and covers doctors’ services and the anesthetist if you need one.
Part B may cover home healthcare services that are not included in Part A coverage. If you remember from our Part A discussion, it does not cover inpatient care if the patient is not formally admitted to the hospital. Part B may step in and help.
Lab tests are covered, even if they are done outside of the facility. Tests inculde preventative care, like mammograms, flu, hepatitis B and pneumococcal shots. (Shingles shots are not included.) Also covered are prostate and other cancer screenings, HIV screening and cervical and vaginal cancer screenings. (Many are once a year). Some durable medical equipment and supplies are also covered.
Outpatient mental health, as well as physical, occupational and speech therapies may be covered – if approved. You may be able to get counseling for obesity, smoking or alcohol abuse.
If you have subscribed to Part B for more than a year, you are eligible for a wellness checkup. This is not a physical, it is a preventative checkup.
Part B will cover a second opinion in case your primary doctor has recommended surgery or some kind of serious treatment. If Doctor 1 and Doctor 2 disagree, coverage will even extend to Doctor 3’s opinion.
What is not covered under Part B
Generally speaking, Medicare does not cover ambulance or emergency room charges. There are special cases that can be approved For instance, if a patient is critically ill or wounded and a mode of transportation other than an ambulance or air rescue would endanger the patient’s health, Part B will pay.
Routine dental care is not covered (emergency services may be). Also not covered: dentures, cosmetic surgery, or acupuncture. Exams for fitting hearing aids and most hearing aids are not covered, although diagnostic evaluations and a limited type of aids are. Once a year routine eye exams are covered, but exams for prescribing glasses are not. (This is where frustration begins to set in.)
Part B will cover many of the services you need. Always be on the safe side and ask first.
Don’t forget, this is Open Enrollment until December 7. If you want to make changes to your plan, call soon.
Next week: What you pay for Part B coverage. We should also point out that coverage discussed here relates to traditional Medicare. Part B under a Medicare Advantage Plan will be discussed later.