Navigating all the possible Medicare choices can be a daunting task. Deciding whether or not to take Medicare Part B coverage can be an especially hard choice. This article will explore the benefits of taking Medicare Part B and explain things you should know and seriously consider before making the final decision on your personal Medicare coverage.
Outpatient Insurance Coverage
The most basic benefit of Medicare Part B is that it gives you insurance coverage for doctor visits. All outpatient products and services fall under Medicare Part B. This covers doctor visits, outpatient surgeries, durable medical equipment and some preventative care.
Most Part B coverage is only for things medically necessary, meaning that it will cover you once you become ill and require treatment. Many preventative care services are not covered. It is good to know, though, that if you do fall ill, you have the means to see a health care provider.
Cost
Medicare Part B is generally much more cost effective than private insurance. Those who qualify for Medicare should be sure to weigh the cost of Part B coverage against the cost of private insurance, especially if you are still employed and have benefits available through your employer.
The premium for Medicare Part B is currently $96.40 per month for most of the population.
After meeting a $135 deductible, Medicare Part B members pay 20 percent of the Medicare-approved amount for medical services rendered.
Example WITHOUT Medicare Part B coverage:
The member visits the doctor for the same illness as in the example above. With no health insurance at all, he is billed the regular rate that the physician charges for this particular service. The member receives a bill for $300 and must pay the full amount.
Example WITH Medicare Part B coverage:
The member has met his yearly deductible of $135. He visits the doctor for an illness and receives treatment. The Medicare-approved amount for the service is $100. The member pays $20 and Medicare pays the remaining $80.
Without Medicare coverage, the amount billed for the service may be much higher given the fact that Medicare has negotiated this rate with the provider.
By having Medicare Part B insurance, the member in question saved $280. Even factoring in a premium of $96.40, he still saved $183.60. That is significant savings.
Penalties for Not Signing Up
If a person becomes Medicare eligible and declines Medicare Part B coverage, she will incur penalties for doing so should she decide to take part in Medicare Part B at a later date.
If you decline Medicare Part B, then decide later to take it, you will have a penalty of 10 percent added to the premium for every 12-month period that you were not enrolled.
Example:
John Doe turns 65 years old on July 1, 2000. He declines Medicare Part B because he simply doesn't feel that he needs it nor does he want to pay a premium of $96.40 each month. On July 1, 2004, he notices many of his friends falling ill and realizes the need for medical coverage. His premium will now be 40 percent higher because he was not enrolled for the four years that he was eligible for coverage. The penalty never goes away, and John Doe will now be paying a 40 percent higher premium for the rest of his life because he declined coverage when he became Medicare eligible.
The exception to the rule is that if the member is covered by another insurance, such as that of an employer, he will incur no penalty for declining coverage. In a time when many people are staying employed well past age 65 (when they become Medicare eligible), this case occurs often. In such a case, no penalty will be added to the premium and the member can simply enroll in Medicare Part B when he retires or loses insurance coverage.
Part B Is Required for Medicare Advantage
Any Medicare-eligible person who wishes to take part in a Medicare Advantage program must be enrolled in both Medicare Parts A and B and must be up-to-date on the premiums for both.
Medicare Advantage programs are often zero premium programs that supplement Original Medicare and can add many valuable services such as preventative care, dental coverage, vision coverage and more.
Physical Exam
When enrolling in Medicare Part B, the member is approved for a "Welcome To Medicare" physical exam. Since Medicare doesn't cover much routine or preventative care, this physical could be very important in detecting any potential health problems.
Members pay 20 percent of the Medicare-approved cost for the physical and are not required to meet the $135 yearly deductible for this service.
Tags: Medicare Part, Part coverage, Medicare Part coverage, preventative care, Medicare Advantage
