As promised, this second part of Making Sense of Medicare will unpack Part B. Original Medicare can get pretty confusing. Misconceptions and misunderstandings can lead to mistakes -- costly mistakes at that! The good news is that these mistakes can be avoided with a bit of knowledge.
Insomuch as we broke down Part A in the previous post into bite-sized pieces (an appetizer so to speak), we will do the same with Part B here (consider this our main course). Hopefully this will help bring clarity and better understanding to what Part B actually covers and how it works. So, pull up a seat and let's dig in ...
If you missed the previous post about Medicare Part A, you can find it here.
Part B - Medical Coverage
Medicare part B covers, you guessed it, medical costs. This includes appointments with your primary care doctor and specialists, as well as other services such as labs, x-rays, diagnostic tests (such as MRIs, CT Scans, Mammograms, Bone Density Scans, Ultrasounds, etc). Outpatient surgeries, treatments, and procedures also fall under Part B, as do durable medical equipment, home health care (covered under A&B), mental health services, and preventative services. Some medications are also covered under Part B, though most are not and, for simplicity and clarity, we will talk about that in a future post when we cover Part D (prescription drug plans).
Deductible
Every year you will be have to pay 100% of the cost of services until you have met the annual deductible amount ($203 in 2021). This amount is subject to change every year. It's not a huge deductible so it shouldn't take long to put it behind you, but until then, Medicare won't be helping with any of your Part B costs (with the exception of some routine preventative screenings, more about that later).
Once you've met your deductible you will generally only have to pay 20% of the costs for covered services and Medicare will pay 80%.
Bonus Tip: Make certain the provider you're using accepts Medicare assignment.
Example:
If your doctor visit costs $100, you will be responsible for $20 and Medicare will pay $80.
Pretty simple, huh? Sounds pretty good too, doesn't it?
Let's look at some other scenarios ...
Example:
If you have a procedure that cost $20,000 you would be responsible for paying $4000. A $100,000 medical procedure would set you back $20,000, and so on.
As you can see, this could pose a tremendous financial risk if you encounter some costly medical needs.
Bonus Tip: It's important to know that there is no limit on how much you could be responsible for paying under Part B because there is no maximum out of pocket limit.
(Don't worry, we'll discuss ways of eliminating or minimizing this risk in a future post).
On the bright side, most preventative screenings and services are 100% covered by Medicare Part B so you can get your routine screenings without worrying about whether or not you can afford it (again, make sure the provider accepts Medicare assignment). It wouldn't hurt to verify that the screening is covered as well. There are some preventative services for which you will be responsible for deductible, coinsurance, or both.
Bonus Tip: Schedule these screenings separately from any other doctor appointments or tests because if you have them done on the same day as you go for something else you may find yourself being billed for coinsurance and/or deductible for what would otherwise have been fully covered.
Because there is a practically endless buffet of Medicare covered services that fall under Part B we won't try to serve them all up here. Just know that in most cases (after your deductible is met), you will be charged for 20% of the costs.
Bonus Tip: If you would like to know more about covered services you can look at a list in the Medicare & You book which is put out annually by Medicare. You should receive it in the mail every year, but you can also find it online.
Also know that there are lots of providers who accept Medicare assignment so getting the care you need shouldn't be difficult at all. Still, I can't stress enough the importance of making sure the provider you use does accept it and that they accept Medicare assignment. A simple call in advance could save lots of time, money, and needless frustration.
Just a few bites of review here before we wrap this up ...
Medicare Part B has a long list of covered services but does not cover everything.
Bonus Tip: Always ask first!
Services generally not covered under original Medicare:
- Routine vision/dental/hearing
- Massage therapy
- Cosmetic surgery
- Long term care
In summary, Medicare Part B helps pay for Medicare covered medical costs and in most cases you will be responsible for 20% (after your annual deductible) and Medicare will pay for 80%. There is no maximum out of pocket so there's no limit to how much financial responsibility you could rack up. You will always want to make sure the provider you use accepts Medicare assignment before using their services.
That's it! Now that we've got this course out of the way you can kick back and digest this information while the next course is being prepared -- Part D (prescription drug coverage).