Understanding What Medicare Part B Coverage Pays For And What It Doesn't

By Ruth Robinson


When you get close to retirement age, you will have a lot of decisions to make. Many prefer to work as long a possible, and others have no other choice. If your children are grown and gone, you might consider downsizing your living accommodations. Some lucky individuals have the means to travel. Once you reach sixty-five, you will most likely qualify for Medicare. You have several choices here as well. You can opt for only Part A. If you decide you need more than this offers, you have the option of selecting Medicare Part B coverage in addition to A.

B is not free, doesn't pay one hundred percent for most things, and is not available for all medical needs. If you want both parts, the Social Security Administration will take a portion out of your monthly check to cover them. The amount can vary from year to year. It only covers about eighty percent of allowable procedures and doctor's visits. You are responsible for the rest. There is an annual deductible you have to pay before the program kicks in at all.

Your benefits are based on two things, one of which is medical necessity. This allows participants to seek a diagnosis for a particular condition and get the treatment needed to relieve it. Unlike Plan A, this insurance does not require hospitalization to approve procedures. It surprises many to learn that clinical studies are covered with this plan. It will pay for hospital stays, surgery, and some types of after care.

One of the great benefits of this section of the program is that it pays for preventive procedures. A lot of people, who either don't have insurance at all or are under insured, put off things like wellness doctor visits, flu shots, and breast exams. Once you reach sixty-five, these necessary procedures become more affordable.

Calling for emergency services can save lives, but it is expensive for those without insurance. Plan B will pay for an ambulance to pick up a patient and take that person to the closest facility with adequate services to assist in the emergency. Patients who want to be taken to specific facilities, especially if they are farther away, will have to pay a portion of the expense.

Senior citizens with mental health problems will have coverage under this plan. It will pay for outpatient care as well as inpatient or temporary hospital care. This is covered under both Part A and B. What is doesn't pay for are personal items such as socks and razors, private rooms, private nurses, a television, or a land line phone in your room.

Prescriptions are generally not covered by this program. There are exceptions that include some drugs infused through equipment, antigens, and some injections for renal failure. It will cover second opinions before surgery. It will also pay for some medical equipment like manual wheelchairs, crutches, walkers, commode chairs, canes, and hospital beds.

What medical benefits you choose to receive will probably depend on the insurance you already have and what you can afford. You should remember that the services offered through Medicare are limited, and most are not free. Supplemental and long term care insurance are private options you may need.




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