One example of this is doctor-prescribed physical therapy. A person can be eligible for Medicare part B in a number of ways. If they are eligible for premium-free Medicare Part A, a person simply in rolls in Medicare Part B and pays a monthly premium. If a person is not eligible for premium-free Medicare Part A, they can become eligible if they are over the age of 65, a US resident (or a permanent resident with five continuous years of residency), because of a disability, or because of end-stage renal disease or ALS.
In addition to the medically necessary services and supplies, Medicare Part B also provides preventative services. These are services which provide healthcare to prevent illnesses (such as the flu) or detect them at an early stage (such as cancer), when treatments are most effective. People enrolled in Medicare Part B pay nothing for preventative services if they come from a healthcare provider.
Medicare Part B provides an initial physical exam, hepatitis B and flu vaccinations, and screenings for diabetes, cancer, and cardiovascular disease. It provides services (such as doctor’s visits, surgery, laboratory tests) and medical supplies (e.g., blood testing equipment, walkers, wheelchairs) which are considered medically necessary to treat some medical condition or disease.
Most people who are enrolled in Medicare Part B pay an insurance premium for their coverage. The standard premium through 2017 was between $134 and $428.60 per month. A new income-based system has been in effect since 2007. Under the current plan, premiums are higher for beneficiaries with income exceeding $85,000 for individuals or $170,000 for married couples. Medicare Part B premiums are routinely deducted automatically from Social Security payments.
Medicare Part B covers a wide range of things such as limited outpatient prescription drugs, second opinions before surgery, and a broad spectrum of mental health services including partial hospitalization, and clinical research. Although Medicare part B covers a broad range of services and supplies it doesn’t cover everything. In the same way as Medicare Part A, Part B coverage is based on state and federal law, as well as local and national decisions, by healthcare providers and Medicare respectively.
The United States government sets pay standards for procedures performed by doctors, nurses, and other healthcare providers under Medicare Part B. They are advised by the Specialty Society Relative Value Scale Update Committee, which is made up of doctors in the American Medical Association.
Original Medicare, which includes Parts A and B, typically pays 80% of medical costs, with the patient bearing 20% of the costs as coinsurance. For this reason, many people seek to obtain coverage for their 20% liability through supplements or Medicare Part C.