Riddled as it is with myriad financial nuances, coverage conditions, and four different “parts,” the process of navigating the Medicare bureaucracy may sound daunting, especially if this is your first time dealing with it. But the benefits of understanding the system can help participants get the best care possible—and save a significant amount of money. And when it comes to Medicare Part B, which received a significant overhaul in 2017 that benefits scores of older Americans, it’s critical to understand the scope of what is and isn’t covered. In short, Medicare Part B is the Medicare program that covers doctor bills and other outpatient costs. It’s one of Medicare’s four programs, each identified by a letter: Part A (hospital insurance), Part B (medical insurance), Part C (managed care plans), and Part D (prescription drug coverage). Almost everyone who is 65 and older is eligible for Medicare Part B. Although it will pay part of many participants’ doctor bills and other outpatient costs, it leaves some services uncovered and pays only a portion of those services that it does cover. Participants may need to fill the gaps in coverage—the costs Part B doesn’t pay—with Medigap supplemental insurance, a Part C managed care plan,Medicaid benefits or other sources. Below, we’ve highlighted what you should know about Medicare Part B coverage and enrollment details for you or a loved one. Medicare Part B Explained Any U.S. citizen or legal resident who’s been in the country for five consecutive years is eligible. What’s more, participants aren’t required to have Medicare Part A in order to enroll in Part B. Every individual enrolled in Medicare Part B pays a monthly premium for it (except for people enrolled in Medicaid, which pays the Medicare Part B premium for them). The premium goes up each year on January 1. In 2019, most people will pay $135.50 per person, per month. Single people (or a married person filing a separate tax return) with an adjusted gross income over $85,000 per year pay higher premiums, as do couples whose combined income exceeds $170,000. Medicare bases these calculations on tax returns from two years before. If for any reason participants’ actual income has dropped significantly in the past couple of years, they can contact Medicare with this information and request that their premiums be adjusted accordingly. For those who don’t enroll in Part B when first eligible for it at age 65 but do enroll later, the premiums will be 10 percent higher for every year of delay in enrollment. Does Part B cover doctor bills? The short answer is yes, as doctor bills are probably the biggest chunk of outpatient expenses that are covered by Part B. The category includes any service by a doctor wherever it’s provided—hospital, doctor’s office, clinic, etc. It also covers any other work performed by the doctor’s staff, as well as any drugs administered in the office. That being said, the two basic coverage rules are that care must be medically necessary, and it must be performed by a doctor who accepts Medicare payment. This means that before participants see any new doctor, they must make sure that the doctor accepts Medicare. With many limitations, Part B also covers some care by a chiropractor. This is only for short-term manipulation of out-of-place vertebrae—neck and back—by a Medicare-certified chiropractor. Before seeing a chiropractor, have the chiropractor’s office check directly with Medicare to ensure coverage.
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18/7/2019 08:57:49 pm
Every individual enrolled in Medicare Part B pays a monthly premium for it,except for people enrolled in Medicaid, which pays the Medicare Part B premium for them.
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