Original Medicare is broken down into Part A and Part B. Medicare Part A covers such healthcare issues as hospitalization, hospice, and skilled nursing facilities. While Part B covers the day to day health issues you might come across. Let’s delve into the details of Part B.

Updated: 4/19/2016

Medicare Part B Covers

In general,Medicare Part B covers:

  • Doctor’s office visits
  • Clinical research
  • Durable Medical Equipment
  • Second opinion before surgery
  • Mental Health
  • Limited Rx*

*Medicare Part B generally covers drugs that you would not administer yourself such as vaccinations. To cover the costs of your drugs you’ll want a separate Prescription Drug Plan.

Medicare Part B Out-of-Pocket Costs

These are your Part B out-of-pocket costs:

  • $174.70 Part B premium for those signed up prior to 2016 and payment is pulled from Social Security*
  • $174.70 Part B premium for everyone else*
  • $240 Part B deductible
  • $0 Preventive Services
  • $0 for Clinical lab services
  • $0 for Home health care services
  • 20% for Durable medical equipment
  • 20% for Doctor’s services
  • 20% Mental Health
  • 20% for Physical, Occupational, and Speech Therapy**
  • 20-40% for Out-patient services at hospital/clinic
  • Part B excess charges vary
  • No limit on your out of pocket costs

*If you make more than 85/170k (ind/family) you can pay more than this per month.
**There may be limits on this type of therapy.

Ways to Cover Your Medicare Costs

If the Medicare Part B costs above seem overwhelming there are two options to consider when first enrolling in Medicare: Medigap and Medicare Advantage. Remember you must be enrolled in BOTH Medicare Part A and Part B to enroll in either of these insurance options.

Medigap
Medigap is standardized Medicare supplemental insurance that helps to fill in the gaps that Medicare leaves. Medigap plans work like this, for example, if you chose the most comprehensive Medigap Plan F it would covers all your coinsurance, copays, coinsurance, excess charges, adds an additional 365 hospital days, offers foreign emergency healthcare, and works in Medicare’s nationwide network. Medigap Plan F premiums are more expensive than MA plans, but generally there are no out-of-pocket costs outside of the premium.

Medicare Advantage
Medicare Advantage does NOT supplement Original Medicare, but rather it REPLACES Original Medicare. This means that Medicare Advantage trades out Medicare’s nationwide network for a local, HMO-like network with added benefits such as Rx, dental, and vision. MA plans offer $0 to low premiums with a max out of pocket of $8850.

For further questions about how to cover your Part B costs call the number above or click here to get an instant Medicare Insurance quote.