2012

Part B - Medical Insurance

Enrolling in Medicare Part B

Automatic Enrollment

·        If you already get Social Security, Railroad Retirement, or disability benefits

·        Must opt out if you don’t want to be enrolled

Initial Enrollment Period (IEP)

·        7 month period.  Starts 3 months before month of eligibility, and includes the month you turn 65 and 3 months after the month you turn 65

General Enrollment Period (GEP)

·        January 1 through March 31 each year

·        Coverage effective July 1

·        Premium penalty

-      10% for each 12-month period eligible but not enrolled

-      Paid for as long as the person has Part B

-      Limited exceptions

 

Part B Coverage

·       Doctors’ services

·       Outpatient medical/surgical services and supplies

·       Diagnostic tests

·       Outpatient therapy

·       Outpatient mental health services

·       Some preventive health care services

·       Other medical services

Part B – COSTS *

MONTHLY PREMIUMS

If Your Yearly Income is

You Pay

File Individual Tax Return

File Joint Tax Return

 

$85,000 or less

$170,000 or less

$99.90 +

$85,001 - $107,000

$170,001 - $214,000

$139.90

$107,001 - $160,000

$214,001 - $320,000

$199.80

$160,001 - $214,000

$320,001 - $428,000

$259.70

above $214,000

above $428,000

$319.7

0

* Applies to Original Medicare Plan (Medicare Fee-for-Service)

Co-Payment: fixed dollar amount after annual deductible is met.

Coinsurance: % of Medicare approved amount after annual deductible is met

 

COSTS FOR COVERED SERVICES AND ITEMS

·       Deductible: You pay the first $140 yearly

·       Blood (as an outpatient)

o   First 3 units in a calendar year: You pay unless the blood is donated

o   Additional units in a calendar year: You pay a portion of the Medicare-approved amount

·       Clinical Laboratory Services and Home Health Services: You pay $0 of the Medicare-approved amount

·       Medical and Other Services: You pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, most preventive services, and durable medical equipment.

·       Mental Health Services: You pay 45% of the Medicare-approved amount for most outpatient mental health care.

·       Other Covered Services: You pay copayment or coinsurance amounts

·       Outpatient Hospital Services: You pay a copayment or coinsurance amount that varies by service for each outpatient hospital service.

 

Covered Preventive Services

·        Abdominal aortic aneurysm screening

·        Bone mass measurement

·        Cardiovascular Screenings

·        Colorectal Cancer Screenings

o   Fecal Occult Blood Test

o   Flexible Sigmoidoscopy

o   Colonoscopy

o   Barium Enema

·        Diabetes screenings

·        Diabetes Self-management Training

·        Flu shots

·        Glaucoma tests

·        Hepatitis B shots

·        HIV screening

·        Mammogram (screening)

·        Medical Nutrition Therapy Services

·        Pap Test and Pelvic Exam (includes breast exam)

·        Physical Exams

o   One-time “Welcome to Medicare” physical exam

o   Yearly “Wellness” exam

·        Pneumococcal shot

·        Prostate cancer screenings

·        Smoking cessation (counseling to stop smoking for people with no sign of disease)

 

What’s NOT Covered by Part A and Part B

·        Items and services Medicare doesn’t cover include, but aren’t limited to:

o   Long-term care

o   Routine dental care

o   Dentures

o   Cosmetic surgery

o   Acupuncture

o   Hearing aids and exams for fitting hearing aids

·        Medicare Part A and Part B don’t cover everything.  If you need certain services that Medicare doesn’t cover, you will have to pay out-of-pocket unless you have other insurance to cover the costs.  Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments.

·        Items and services that Medicare doesn’t cover include, but aren’t limited to, long-term care, routine denture care, dentures, cosmetic surgery, acupuncture, hearing aids, and exams for fitting hearing aids.

·         To find out if Medicare covers a service you need, visit www.medicare.gov, and select “Find Out What Medicare Covers”, or call 1-800 MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048.

 

For additional information or details, please contact SHIP at 301-590-2819