What Does Medicare Part B Cover?

For those who are seeking more insurance information, Medicare is the federal health insurance program created specifically for seniors, 65 years of age and older, as well as certain younger people with disabilities and those suffering from End-Stage Renal Disease. Given the sensitive nature of the patients the plan covers, it is of the utmost importance to always ensure this coverage is sufficient and that it covers all necessities for the elderly and ill individuals who subscribe to this plan. Although there are four distinct types of coverage under the Medicare banner (Medicare Part A-Medicare Part D), the purpose of this post is to go over the coverage information for Medicare Part B.

Medicare Costs

Before we delve into what Medicare Part B covers, we must first understand that Medicare also carries its share of costs. Firstly, the monthly premium is $134. Although this is considered fairly inexpensive, one must also keep in mind that patients are often on fixed/ limited incomes. Moreover, despite this being the official cost, this is not what the average beneficiary is responsible for paying. In fact, given that the vast majority of Medicare recipients are elderly (70 percent), most premiums are paid directly from the patient’s Social Security benefits. Furthermore, given a specific rule addressing the correlation between Medicare premiums with Social Security cost-of-living adjustments, premiums for this demographic tend to go up more slowly than the others. That said, on average, they are paying $109 monthly.

On the flip side, overall, the remaining 30 percent pay the entire $134 monthly premium. This percentage includes those who are new to Medicare beneficiaries as well as those who have not yet filed for Social Security. Furthermore, being impoverished or unemployed is not the only way in which your income can affect your eligibility and/or premiums. Those who make too much are also expected to pay higher premiums. Based on the patient’s modified adjusted gross income from two years ago, as well as your tax filing status. Those who make over $85,000 have to pay an increased premium.

Medicare Part B Coverage

Now that we’ve gone over the costs of Medicare, let’s look into what it covers. As mentioned, Medicare Part B supplies medical insurance to the elderly as well as a variety of others. Covering a variety of medical supplies and necessities, Medicare part B covers outpatient visits to doctor’s offices, clinics, hospitals, as well as an array of other medical facilities. Furthermore, Medicare part B also covers an array of preventative services as a means of preventing illness and/or early detection. Although there are now four distinct categories of Medicare, Medicare Part A and B are considered Original Medicare.

Medicare Part B covers the following:

Doctor visits- Visit your doctor’s office for things such as physical exams, regular check-ups, for referrals, and other necessary medical actions. Your Medicare plan will cover the majority of the services needed as well as subsequent materials such as medications and other paraphernalia. For instance, the Gonzaba Medical Group offers quality healthcare to elderly patients in the San Antonio area.

Laboratory tests and X-rays- In addition, doctor’s visits are but one aspect of maintaining one’s physical health. Laboratory testing is commonly recommended for the elderly as well as those with various health issues as their health is already considered to be compromised in some way, having X-rays and other laboratory testing options can be some of the best methods of preventing illnesses and/or detecting them early.

Emergency ambulance services- Although this is highly uncommon, the costs associated with one ride in an ambulance can be astronomical and unfortunately, if you are in need of an ambulance ride, you probably are not in the position to negotiate prices. Fortunately, Medicare part B will cover the vast majority of these costs.

Mental health services – Although it is thought to be separate from physical health, mental health is an intricate part of your overall well-being. Moreover, given that the elderly are especially prone to Alzheimer’s, dementia and other types of mental health issues, offering patients mental health services is a vital element of Medicare.

Durable medical equipment – Depending on which types of illnesses or ailments a patient may have; medical equipment is a term that can refer to an array of materials. For instance, those who suffer from diabetes may need a steady supply of needles to test their glucose levels. On the flip side, those with mobility issues may need equipment such as canes, wheelchairs, scooters and the like.

Preventive services (Pap tests, flu shots, and screenings) – Moreover, as we age, preventative medicine begins to take center stage. Rather than waiting for a problem to emerge, healthcare professionals will recommend an array of test and other procedures to prevent their health from drastically deteriorating.

Rehabilitative services (physical therapy, occupational therapy, and speech-language pathology services) – Lastly, in the unfortunate event that a patient experiences a serious medical issue, rehabilitation services are provided to help them regain their health as well as their sense of autonomy. Major accidents, strokes, and seizures, as well as other conditions, often act as the catalyst for a poor bill of health. Fortunately, rehabilitation services are offered under Medicare part B.

Although it provides high-quality coverage, it is still up to every patient to find a service provider they can trust. For seniors seeking high-quality medical care in San Antonio, the Gonzaba Medical Group is a great practice to receive sound medical care and advice.

What Does Medicare Part A Cover?

Open enrollment for Medicare brings about several questions, including what costs and services each part covers. Seniors who are considering Medicare enrollment should understand what each section covers, including the costs associated with Medicare Part A.

Medicare Part A is the primary coverage that Medicare recipients receive, and it covers a variety of services, including skilled nursing facility care, hospice, home health services, nursing home care and hospital care. It works like an insurance for hospital care and services. But Medicare Part A does not cover every hospital-related cost. Here are a few factors to consider:

Hospital Care

When it comes to hospital care, Medicare Part A primarily covers the costs associated with hospital care. Hospital care under Medicare Part A includes long-term care hospitals, inpatient hospital care, and skilled nursing facility care.

  • Long-Term Care Hospitals. When patients have multiple serious conditions, long-term care hospitals serve as a key component of providing patients with specialized care. If a Medicare policyholder receives care while staying in a long-term care hospital, they can have peace of mind that it is covered. However, Medicare policyholders are still required to pay a deductible during the benefit period — the period the patient is admitted in the hospital and receiving inpatient care until 60 days following the time the patient no longer receives inpatient care. This deductible only needs to be paid once during the benefit period.
  • Inpatient Hospital Care. Medicare Part A covers hospital services and amenities, including meals, semi-private rooms, and inpatient treatment medications. This care also covers inpatient mental health care and inpatient care even when Medicare policyholders are taking part in a qualified clinical research. The care that Medicare policyholders receive at long-term care hospitals, psychiatric hospital, inpatient rehabilitation facilities, critical access hospitals and acute care hospitals are covered under Medicare Part A. But keep in mind that inpatient hospital care does not cover amenities, such as a phone or TV, in the room if these amenities are not inclusive of the charge. It also does not cover personal care items, such as shaving cream or razors. Other services that are not included are private-duty nursing and private rooms that are not medically necessary. Inpatient hospital care also requires Medicare policyholders to pay deductibles and make coinsurance payments depending on the length of stay in the hospital. For instance, patients do not have to pay a coinsurance payment for inpatient care that does not last longer than 60 days. However, a $335 coinsurance payment is required in 2018 for patients who receive inpatient care and services between days 61 and 90.
  • Skilled Nursing Facility Care. When Medicare policyholders require skilled nursing care, they can take advantage of the coverage benefits received under Medicare Part A. This hospital insurance also covers this specialized care when patients receive it at a skilled nursing facility. For instance, Medicare policyholders can receive coverage for services, such as dietary counseling, medications, skilled nursing care, a semi-private room, and required occupational or physical therapy, when these services are provided in a skilled nursing facility. However, there are limitations to this benefit. For example, patients who break their skilled nursing facility care for more than 30 days must receive three days of inpatient care before they can receive extra skilled nursing facility care coverage. No coinsurance is required for 20 days, but starting on day 21, patients can expect a coinsurance payment of $167.50 in 2018, and any service or cost beyond the 100th day must be paid by the patient.

Nursing Home Care

If nursing home care is medically necessary, Medicare Part A may cover nursing home care services. Some services that may be covered under this benefit may include, such as changing sterile dressings. However, if it only covers custodial care, such as getting dressed or bathing, these services are not covered by Medicare.

Home Health Services

Home health services, such as speech-language pathology services, skilled nursing care that is intermittent and physical therapy, are covered by Medicare Part A. Under Original Medicare, these services are covered at no cost to the patient, with the exception of durable medical equipment, which patients will have to pay a partial cost. Other home health care services may include part-time home health aide services and medical supplies intended for use at home. However, home health services under Medicare Part A do not cover personal care, home-delivered meals, round-the-clock home care or homemaker services, such as cleaning and shopping.

Hospice

Seniors who qualify for hospice care can expect a variety of services and amenities covered under Medicare Part A, such as grief and loss counseling, social work services, dietary counseling, doctor services, and prescription drugs for pain relief. Hospice care is completely covered under Medicare Part A. However, policyholders are expected to pay a $5 copayment per medication for pain relief or a similar prescription drug. What is not covered under Medicare Part A includes room and board at the patient’s residence or a nursing home where the patient lives if these places are where hospice care services will be rendered.

Final Thoughts

Understanding the fundamentals of what Medicare Part A covers is important for deciding which healthcare policy best meets senior healthcare needs. It’s also key to use providers who accept Medicare coverage to effectively leverage benefits. Consider using healthcare professionals who understand Medicare and who can help with a variety of healthcare options that seniors can leverage, such as Gonzaba. Take advantage of Medicare benefits, and schedule an appointment with Gonzaba for vital senior healthcare services.