Health care coverage for people age 65 and older can be confusing. Medicare has Parts A, B, C, and D and additional options such as F, M, and N. After a while, it sounds like alphabet soup. As you try to sort through all this, you may be asking, What is Medicare Part B?
Medicare Part B will help pay for outpatient services they consider medically necessary to treat or prevent a disease or condition. This article discusses what original Medicare Part B covers. If you have a different Medicare plan, you might have additional benefits, but you must receive at least the same benefits that original Medicare provides.
What Medicare Part B Covers
Medicare covers 100 percent of some items and services. Some examples are:
- Lab work
- Home health care
Medicare will pay 80 percent of the Medicare-approved rate for most outpatient medical services. The portion you must pay depends on whether your doctor accepts Medicare assignment or not, as discussed in this article.
Medicare only pays 50 percent of the Medicare-approved rate for outpatient mental health treatment. The patient is responsible for the remaining 50 percent.
Medicare rarely pays for:
- Eyeglasses, contacts, hearing aids, or orthopedic shoes
- Nursing home for custodial care only (they can cover skilled nursing care)
- Most vaccines
- Most dental care
- Check-ups or physicals
- Foot care
- Cosmetic surgery
- Prescription drugs, unless the doctor administers the medication, such as a shot
How Much Medicare Part B Costs
If you make $85,000 a year or less ($170,000 a year for couples filing joint returns) in 2017, your monthly Medicare Part B premium will be $134 or less. People with high income can pay as much as $428.60 a month for Part B.
You will have an annual deductible of $183 a year (2017). You must pay 100 percent of your deductible before Medicare pays for anything. After you satisfy your annual deductible, Medicare will pay part of what they consider “reasonable charges” for your medical care, and you will pay a copay.
The Difference Between Accepting Assignments and Limiting Charges
You must find out if your doctor “accepts assignment.” Many states require doctors who accept Medicare patients to accept assignment.
If your doctor accepts assignment, he accepts whatever Medicare pays plus your 20 percent copay as payment in full. If your doctor does not accept assignment, Medicare’s rule on limiting charges will only allow him to require payment of 115 percent of Medicaid’s approved rate for the service, regardless of how much the doctor charges. Medicare pays 80 percent and you pay 35 percent. For example:
A doctor charges $200 for a routine office visit. Medicare’s approved rate for this service is $100. Medicare will pay $80 (80 percent of their approved rate) and the patient will pay $20 copay.
- If the doctor accepts Medicare assignments, the doctor accepts the total of $100 from Medicare and the patient as payment in full.
- If the doctor does not accept Medicare assignments, the patient must pay the doctor $35 ($20 copay plus $15 for the limiting charge. The doctor will receive $80 from Medicare and $35 from the patient, for a total of $115. The doctor cannot force the patient to pay more. This video explains accepting assignments and limiting charges.
Register for Medicare when you are supposed to. If you do not, Medicare will charge you a late enrollment fee, which is not a one-time penalty. The late enrollment fee means you would pay higher premiums every month for the rest of your life.
This blog talks about the general law. Every state has different laws, so be sure you talk with a local elder law attorney.
Medicare Interactive. “Medicare Part B coverage.” (accessed October 20, 2017) https://www.medicareinteractive.org/get-answers/medicare-covered-services/medicare-coverage-overview/medicare-part-b-coverage
Centers for Medicare & Medicaid Services. “What Part B covers.” (accessed October 20, 2017) https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html
Centers for Medicare & Medicaid Services. “How much does Part B cost?” (accessed October 20, 2017) https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
CMSHHSgov. “Parts A & B – Alphabet Soup.” (accessed October 20, 2017) https://www.youtube.com/watch?v=djD4X1USbro