Medicare Parts A & B

You cannot be denied part B coverage. Any doctor or qualified health care provider (see if your doctor qualifies here) in the U.S. who participates in the Medicare program and is accepting patients must provide you this coverage. You may be charged a penalty if you don’t sign up when you are first eligible, unless you qualify for a special enrollment period.

Primarily for: Medically necessary and preventative outpatient services & doctor visits

Covers:

• Doctor visits, including in the hospital
• Annual wellness visit and preventive services, like flu shots and mammograms
• Lab services, like blood tests
• X-rays and some other diagnostic tests
• Lab Services, like blood tests
• Some health programs, like smoking cessation, obesity counseling and cardiac rehab
• Physical therapy, occupational therapy and speech-language pathology services
• Diabetes screenings, diabetes education and certain diabetes supplies
• Metal health care
• Durable medical equipment for use at home, like wheelchairs and walkers
• Ambulatory surgery center services
• Ambulance & emergency room services
• Skilled nursing care and health aide services for the homebound on a part time or intermittent basis

The standard premium for Part B $135.50/mo, but may be higher depending on your income

• Each income bracket has its own standard premium
• Deductible & co-insurance
• $185/yr. After your deductible is met you typically pay 20% of the Medicare-approved amount for most doctors services (including while you are a hospital inpatient), outpatient therapy, and durable medical equipment.
• Clinical lab services: $0 for medicare approved services
• Home health care: $0 for home health care services, with 20% of Medicare approved amount for durable medical equipment

Outpatient mental care:

• Nothing for yearly depression screening if your doctor or health care provider accepts assignment
• 20% of Medicare approved amount for visits to diagnose or treat your condition.
• If you get services in in a hospital outpatient clinic or hospital outpatient department, you may to pay an additional co-payment or coinsurance amount to the hospital

Partial hospitalization mental health services: You’ll pay a percentage of the medicare approved amount for each service you get if your health care professional accepts assignment.

• • You also pay coinsurance for each day of partial hospitalization.

Outpatient Hospital Services:

• Usually you’ll pay 20% of the Medicare approved amount for doctor or other health care provider’s services. For services that can also be provided in the doctors office that you receive at home, you may pay more. However, this additional co-payment will be capped for the service is capped at the inpatient deductible amount.
• In addition to the amount you pay the doctor, you’ll also usually pay the hospital a co-payment for each service you receive in a hospital outpatient setting, except for certain preventive services that don’t have a co-payment. In most cases, the co-payment can’t be more than the Part A hospital stay deductible for each service.
• The Part B deductible applies, except with preventive services.
• If you get outpatient services in a critical access hospital your co-payment may be higher and may exceed the Part A hospital stay deductible.