Now that we have a good understanding of Part A benefits and it\’s general coverage for facility (loosely translated as hospital, surgicenter, skilled nursing, and hospice care) based care, let\’s look at Part B, logically our next letter in the alphabet. Generally, Part A is facility care while Part B can be thought of as physician, out-patient, and preventative benefits. You can think of Part B as everything Medicare covers outside of inpatient care (Part A) and out-patient medication (Part B). It\’s quite different from both so let\’s take a closer look at Part B.

First, we need to speak about Part eligibility and cost because this a major difference. Most people are going to pay for Part B coverage. Part A is generally paid for through taxes during employment over the course of a person\’s life. Part B is different and will likely feel the blunt of cost controls going forward. First, you must sign up for Part B. It is not automatically extended to eligible members the way Part A generally is. You must also pay a premium for Part B coverage. As Medicare started to show signs of financial strain, Part B became means tested which means that you will pay more for Part B premium if you have great income on average. You can expect to see this increased premium go higher over time as Medicare tries to shore up it financial house. The premium is paid monthly and can even be taken from your Social Security check automatically. The key take away is that you probably (most people do) need to actually enroll and that you will pay for this coverage separately from any charge to have medicare supplemental insurance. Now, let\’s look deeper into what Part B covers.

First, you will have an annual deductible that you need meet. This deductible is $162 for 2011 but you can expect that it will go up over time. The deductible is calendar year (Jan 1st through Dec 31st) and resets each January. Once the deductible is met, you will then pay 20% of the charges for allowable expense for the remainder of the year. If you have additional coverage such as Medicare supplement insurance or Advantage plan, you may get this deductible and 20% co-insurance covered depending on the plan you choose. Part B generally covers physician charges and outpatient expenses that are allowed and not covered under Part A on an inpatient facility basis. This can be the doctors office, labs, outpatient surgeries, and allowed preventative services. Medication is not covered under Part B and we\’ll cover that in Part D.

There are two ways to find out if a particular benefit is covered under Part B. First there, the Medicare benefit handbook (different from the Medicare and You handbook) which is handy since it\’s alphabetized by actual benefit name such ad Diabetes screening. This is generally how people search for a given medical issue they are dealing with so we advise this first. There\’s also the medicare.gov benefit database where you can get even more specific information by entering in keywords such as \”routine physical\”, etc. Both resources have made searching for eligible benefits much easier in the last few years.

One quick but important note on Part B. If you choose to wait to elect Part B after you are eligible (assuming you do not have another eligible window such as leaving group etc, you may a higher rate for this benefit if you eventually opt for it. There may also be a delay from when elect Part B to when the benefits actually kick in. It\’s best to discuss your situation with a licensed agent as Medicare is only getting more complex in terms of the rules.

Author Bio: Dennis Jarvis is a licensed insurance agent concentrating on medicare supplement insurance. Find more articles and guidance about medigap plans.

Category: Finances
Keywords: part b, medicare supplement insurance, medicare supplement, medigap, medicare