Index | Medicare | Medical Insurance
Medical Insurance (Part B of Medicare) is aimed at helping you pay for doctors' services, both inpatient and outpatient, such as outpatient physical, speech and occupational therapy services. Medical Insurance also helps pay for ambulance services, immunosuppressive drug therapy after receiving a Medicare-approved transplant organ, laboratory tests and X-rays (including portable diagnostic X-ray services), durable medical equipment and supplies. With this plan you can be subject to some preventive services and home care services usually not covered under Medicare Hospital Insurance (Medicare Part A). Custodial or long-term care, however, remains out of Medical Insurance coverage.
Some of the services require specification for you to be able to understand how Medicare Part B works, what services it includes, what services it excludes and how you can apply for the services you need. One of the points requiring specification is the range of medical equipment beneficiaries are rendered. The durable medical equipment usually includes oxygen equipment, wheelchairs, walkers, arm, back, leg or neck braces, one pair of eyeglasses after cataract surgery, infusion pumps, etc. You may get access to the required items of medical equipment in two ways. Some of the equipment can be rented and some must be purchased. Sometimes you can be asked to present a document certifying the medical necessity of a certain item of equipment for Medicare to verify and cover the cost.
Medical supplies you will be provided under Medical Insurance include surgical dressings, blood glucose strips, splints, casts, etc. Generally, you do not need any certification to receive the supplies you need due to your medical condition. What you need is to make sure that the supplier works under Medicare.
As for ambulance transportation, Medical Insurance covers ambulance service to the closest hospital if the personnel and equipment meet Medicare requirements, or if transportation in any other vehicle can be fraught with fatal danger for an individual. In the latter situation Medicare Part B reimburses the expenses.
When it comes to covering health care expenses, Medicare generally pays 80% of the allowable Medicare Part B services, including doctoral charges for care received in hospital. The beneficiary covers only 20%, which is known as co-insurance payment. However, if there are additional expenses to satisfy your medical needs, which are beyond the Medicare-approved amount, you may be billed more than 25% over what Medicare approves. For some outpatient services, for example, mental health, you may be billed 50% of the Medicare-approved charges.
Medical Insurance is not devoid of some gaps that may incur financial losses. Medicare Part B Plan requires you to pay an annual deductible ($131 for 2007) and monthly premiums ($93,5 or more depending on your income for 2007). The monthly fee is usually taken right out of your Social Security payment. Moreover, Medical Insurance does not include Prescription Drug coverage, which means that you will have to pay for medication. It is reasonable to apply to one of the prescription drug plan options (see the corresponding section "Drug Coverage"). But again you must be ready for premiums and deductibles. These charges may seem excessive; therefore, you should consider all the available options. Keep in mind that your Medicare Part B premiums may be paid through a Medicare Savings Program applying to qualified Medicare beneficiaries, specified low-income Medicare beneficiaries, qualified individuals (QI-1) and qualified disabled working individuals. You may reasonably opt out of Medical Insurance if you are still covered by employer or union health insurance which will be primary to cover your medical treatment expenses.
If you are applying to a provider who is not participating in Medicare, you will incur greater expenses. The cost you will have to pay in this case depends on whether your Medicare has a fixed limit on the expenses you can be charged (also referred to as the "charge limit") by a non-participating provider. The charge limit is normally over 15% of the Medicare-approved amount. At the same time you should know that some providers do not accept the "charge limit" (such as some medical equipment suppliers) and in this case Medicare will not reimburse you for excess charges.
Medicare Part B is voluntary, but it really helps pay for the covered medical services and items when they are medically necessary. Like with any other type of insurance coverage, it is advisable to make informed decisions about the necessity and validity of enrolling in Medical Insurance. It may turn out that with this type of insurance you are buying peace of mind.