What is Part A?
Part A of Medicare is your hospital coverage. It covers the following:
- Inpatient hospital care
- Meals while you’re in the hospital
- Medications administered while you’re in the hospital
- Skilled nursing facility care
- Nursing home costs
- Hospice care
- Home health care as long as it is deemed medically necessary
While Medicare Part A covers some nursing facilities, it does NOT cover long-term care at a nursing facility.
What Else Does Medicare Part A NOT Cover?
- Most dental care
- Eye exams
- Cosmetic surgery
- Routine foot care
- Hearing aids
How Can I Find Out If Medicare Covers My Care?
Generally speaking, the above list is what Medicare Part A covers. However, many people want to be certain that Medicare will cover their specific situation. It’s also important to know exactly how much Medicare will cover, because it’s not always one-hundred percent. If you have an appointment coming up, call your doctor’s office. Ask them to check if Medicare is covering your upcoming visit. Your doctor should be able to help you figure this out.
What Is Part B?
Medicare Part B is your Medical Insurance. It covers two types of services, medically necessary services and preventative services. Medicare Part B covers many medical situations, and it’s essential to know precisely which ones are included so that you can prioritize your health.
Who Is Eligible for Part B?
Your eligibility for Part B depends on whether you qualify for premium-free Part A or not. If you are eligible for the premium-free Part A, you can enroll in Part B as soon as you become eligible for Part A.
If you must pay a premium for Part A, you are eligible for Part B if you are 65 years or older, are a US resident, AND you’re either a United States citizen or a green card holder who has been in the United States for the past five years.
What Are Considered Medically Necessary Services?
Medicare Part B will cover services or supplies that are necessary for diagnosing and treating a medical condition, so long as the services or supplies meet accepted standards of medical practice. If your doctor accepts assignments, you will usually pay nothing for most services. An assignment is when the doctor has agreed to be paid directly by Medicare and accept the Medicare-approved amount for that specific service. In this case, you won’t be billed for anything other than your deductible and coinsurance.
What Are Preventative Services?
Part B also covers services that are intended to prevent illnesses. The following is a list of some of the major services that are covered under this section, though the list is not exhaustive.
- Alcohol Misuse Screening and Counseling in Massachusetts
If you’re an adult who uses alcohol but you don’t meet the criteria for alcohol dependency, Medicare Part B will cover an alcohol misuse screening once per year. If the doctor who does your screening determines that you need treatment because you’re abusing alcohol, you will be permitted to attend four brief face-to-face counseling sessions per year. This counseling must be done in a primary care setting, like a doctor’s office.
- Cardiovascular Disease Screening in Massachusetts
Medicare Part B covers cardiovascular disease screening once every five years. Cardiovascular screenings include blood tests for cholesterol, lipid, and triglyceride levels. Obtaining these levels helps detect a condition that might lead to a heart attack or stroke.
- Cervical and Vaginal Cancer Screening in Massachusetts
If you have Medicare Part B, your plan covers pap smears and pelvic exams to detect vaginal or cervical cancers. It will cover these tests once every two years. A clinical breast exam to check for breast cancer is also covered. If you have had an abnormal pap smear in the last 36 months, you are at high risk for cervical or vaginal cancer or you are of child-bearing age, your screenings will be covered once per year. An HPV test is also covered once every five years if you are between the ages of 30 and 65.
- Colorectal Screening in Massachusetts
These include multi-target stool DNA tests, screening barium enemas, screening colonoscopies, fecal occult blood tests, and screening flexible sigmoidoscopies.
- Diabetes Screening in Massachusetts
If your doctor has determined that you are at high risk of developing diabetes, you may be eligible for up to 2 screenings per year. Medicare Part B will cover glucose laboratory screening tests if you have any of the following risk factors: high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar.
- Flu Shots
- COVID-19 Vaccine
- Hepatitis B Shots
- Yearly Wellness Visit
Medicare Part B also covers things like ambulance services, durable medical equipment, clinical research, and mental health services, such as inpatient, outpatient, and partial hospitalization programs.
What Percentage Does Part B Cover?
If you have Original Medicare Part B coverage with no other plans in place, then you will have a twenty percent coinsurance on all Part B services. One of the downsides of Part B is that there is no limit to the amount that you could be responsible for. Simply put, with Medicare Part B insurance, there is no maximum out of pocket. This is why it’s so important to sign up for a Medicare Supplement to help cover that extra twenty percent.
Example: Your hospital bill is $100. You are responsible for paying $20. Your next bill is $100,000 for surgery. You are responsible for $20,000.
What Does Medicare Part B Cost?
Your Medicare Part B premium is based on your annual income and whether you file your taxes individually or jointly. The average Part B Premium in 2022 is $170.10. This usually comes out of your social security check before you receive your payment.
Part B Deductible in Massachusetts
In 2022, the deductible for Part B is $233. This means that Medicare won’t kick in and offer any coverage until you pay $233. After that, your coverage will begin.
Part B Coinsurance
Coinsurance is the amount of money that you are responsible for after Medicare has paid its part. After your deductible is paid, you will be responsible for twenty percent of the Medicare-approved amount for most services.
Late Enrollment Fee
If you don’t sign up for Part B on time, you will be charged a fee once you do enroll. You will have to pay this late fee for the entire time that you are enrolled in Part B. Your monthly premium could be increased by ten percent for every 12 months that you could have signed up for Medicare Part B but didn’t. In order to make sure you don’t get charged a late fee, make sure you sign up for Part B as soon as you are eligible.
Example: You are eligible for Medicare Part B in January of 2021. You enroll in Part D in January of 2022. Your late enrollment fee will likely be a twenty percent increase over the standard premium.