Medicare Part B
Medicare Part B helps cover medically necessary services and supplies needed for the diagnosis or treatment of your health condition. Medicare defines medically necessary as “healthcare services or supplies needed to diagnose or treat an illness, injury, condition or disease, or its symptoms and that meet accepted standards of medicine.” This includes outpatient services received at a hospital, doctor’s office, clinic, or other health facility. Part B entitles you to an annual “Wellness” visit to your Primary Care Physician that is a qualified provider and also helps cover many preventive services to prevent illness or detect them at an early stage. Together, Medicare Part A and Part B are known as Original Medicare.
Medical services and supplies covered by Medicare Part B include doctor visits, laboratory tests and X-rays, mental health services, rehabilitation services, including physical therapy, occupational therapy, and speech-language pathology, clinical research, getting a second opinion before surgery, limited outpatient prescription drugs, supplies such as walkers or wheelchairs, among other things. One additional service covered by Part B is transportation by ambulance. Medicare covers and helps pay for ambulance services only if other types of transportation will endanger your health and will only cover and help pay for you to be transported to the nearest medical facility that’s able to give you the care you need. If you choose to be transported to a facility farther away you may have to pay more.
Another service Part B covers is Durable Medical Equipment (DME) that your doctor prescribes for use in your home. DME must be long lasting equipment that is used for medical reasons and has an expected lifetime of at least 3 years. Only your doctor can prescribe medical equipment for you. DME that Medicare covers includes, but isn't limited to air-fluidized beds and other support surfaces (these supplies are only rented), blood sugar monitors, blood sugar (glucose) test strips, canes (except white canes for the blind), commode chairs, continuous passive motion (CPM) machine, crutches, hospital beds, infusion pumps and supplies (when necessary to administer certain drugs), manual wheelchairs and power mobility devices, nebulizers and nebulizer medications, oxygen equipment and accessories, patient lifts, sleep apnea and continuous positive airway pressure (CPAP) devices and accessories, suction pumps, traction equipment, and walkers. All people with Part B are covered. Medicare pays for different kinds of DME in different ways. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.
One of the most important benefits of Medicare Part B is the preventive services that it covers. These services include health care that is used to prevent illness or detect illness at an early stage. Medicare.gov lists screenings and shots that fall under preventive services. They include things such alcohol misuse screenings & counseling, cardiovascular disease screenings, colorectal cancer screenings, depression screenings, diabetes screenings, glaucoma tests, lung cancer screening, mammograms (screening), as well as shots such as flu shots, hepatitis B shots, and pneumococcal shots.
Although Medicare Part A and Part B are great programs that cover a lot of services, they are not a one-size-fits-all program because people have different medical needs as they age. When applying for Medicare, you have options about the portions of the program in which you want to enroll. Choosing a policy can be daunting, but conducting your own research ahead of time will help you make a more informed decision about your healthcare.