Explanation of Medicare Part B

Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part B.

Medicare Part B Premium

Most people have to pay a premium for Part B. You can check to see if you are qualified to receive help from your state to pay for premiums or deductibles. Otherwise, the premium is usually deducted from a Social Security, Railroad Retirement or Civil Service Retirement check. The Part B premium can also be paid every quarter or through the electronic payment option, or Medicare Easy Pay. Premiums will be based on income beginning January of 2007.

What is Medicare Part B?

Medicare Part B is a medical insurance provided by the federal government to eligible beneficiaries. The coverage provided by Part B includes medically necessary doctor's services, outpatient care, and most other services that Part A does not cover such as some physical or occupational therapies and some home health care services. Part B covers preventive services as well.

What does Medicare Part B Cover?

Medicare Part B covers many services, tests, preventive treatments, etc. that are common among health care patients, but are not covered in the Part A plan. Though many services and products are covered, keep in mind that Part B is still not a 100% insurance coverage plan. So, as with any other insurance policy, you should understand the plan and coverage completely upon enrolling. Part B helps cover only the medically necessary services listed below:

• Tests, Labs and Screenings
• Preventive services include exams, lab tests, or screening inoculations that will help prevent, manage, or diagnose a medical problem.
• Glaucoma tests are covered once per year if performed by a legally authorized eye examiner.
• Bone mass measurement is covered every two years (or as medically necessary). This is to see if you are at risk for broken bones.
• Lab Services such as blood tests or urinalysis are covered.
• Colorectal cancer screenings to find any pre-cancerous growths. Tests may include (a) annual fecal occult blood test, (b) flexible sigmoidoscopy (every four years), (c) screening colonoscopy (every ten years), or (d) barium enema (every four years).
• Diabetic screenings are covered if you have high blood pressure, dyslipidemia, obesity, or high blood sugar.
• Diabetic supplies covered include monitors, test strips, lancet devices, and therapeutic shoes.
• Diabetic self-management training is covered if prescribed by your doctor.
• Cardiovascular screenings to help prevent heart attack or stroke are covered. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.

Doctor, Hospital and Home Health Care

• Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home use medical equipment such as wheelchairs, hospital beds, walkers, oxygen equipment, and other medical supplies.
• Chiropractic services will be covered if it is to correct one or more of the bones that has moved out of place in your spine subluxation).
• Ambulance services are covered if any other form of transportation would endanger your health.
• Blood (pints) that you receive during an outpatient visit or another Part B covered service.
• Clinical trials may be covered if it will help to diagnose, prevent, or treat diseases.
• Ambulatory surgery center fees are covered for approved services.
• Emergency room services for bad injuries, severe illness, or any time you believe your life is in danger.
• Doctor services do not include routine physical exams except the one time "Welcome to Medicare" exam.
• Eyeglass coverage is limited to one pair of glasses and standard frames after cataract surgery.

Preventive Shots

Flu shots are covered one time per year during flu season.

Three hepatitis B shots are covered if you are at medium or high risk.

Additional services covered include, but are not limited to:

• Hearing and balance exams
• Mammograms
• Dialysis
• Pap tests or pelvic exams
• Mental health care
• Medical nutrition therapy
• Hospital services
• Occupational therapy
• Outpatient surgery service and supplies
• Limited prescription drugs
• Practitioner services
• Physical therapy
• Prosthetic devices
• Transplant services

Overall, Part B will provide additional coverage to help minimize your health care insurance worries. Whatever health care insurance coverage you choose, make sure you have a clear understanding of options, coverage, and premiums. Seek a Medicare representative that will take time to explain what type of coverage you will receive and will offer clear instructions for signing on with a Medicare program.