rcm glossary

Medicare Part B

Medicare Part B is a federal health insurance program that covers outpatient medical services, including doctor visits, preventive care, and medical supplies.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is Medicare Part B?

Medicare Part B is a component of the federal health insurance program known as Medicare. It primarily covers outpatient medical services and supplies that are considered medically necessary to diagnose or treat a disease or condition. Part B is available to eligible individuals who are 65 years or older, as well as certain younger individuals with disabilities or specific medical conditions.

Medicare Part B is one of the two main parts of Original Medicare, the other being Medicare Part A, which covers inpatient hospital care. While Part A is generally provided at no cost to most beneficiaries, Part B requires the payment of a monthly premium. The premium amount is determined annually and is based on the beneficiary's income.

Difference between Medicare Part A and Part B

Medicare Part A and Part B differ in terms of the services they cover and the costs associated with each part.

Here are some key differences between the two:

1. Coverage:  

- Medicare Part A: Part A primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care services.  

- Medicare Part B: Part B covers a wide range of outpatient services, including doctor visits, preventive services, laboratory tests, durable medical equipment, and certain medications administered in a healthcare setting.

2. Cost-sharing:  

- Medicare Part A: Beneficiaries typically do not pay a monthly premium for Part A if they or their spouse have paid Medicare taxes while working. However, there are deductibles, coinsurance, and copayments associated with Part A services.  

- Medicare Part B: Beneficiaries are required to pay a monthly premium for Part B coverage. In addition to the premium, there is an annual deductible, and beneficiaries are responsible for coinsurance or copayments for covered services.

3. Enrollment:  

- Medicare Part A: Most individuals are automatically enrolled in Part A when they turn 65 and are already receiving Social Security benefits. Others can enroll during the Initial Enrollment Period (IEP) or Special Enrollment Period (SEP).  

- Medicare Part B: Enrollment in Part B is not automatic and requires individuals to actively sign up during their Initial Enrollment Period (IEP). The IEP is a seven-month period that begins three months before the month of their 65th birthday.

Examples of Medicare Part B Coverage

Medicare Part B covers a wide range of services and supplies that are essential for maintaining good health and managing medical conditions.

Here are some examples of services covered by Part B:

1. Doctor visits: Part B covers visits to doctors, specialists, and other healthcare providers. This includes routine check-ups, consultations, and follow-up visits.

2. Preventive services: Medicare Part B provides coverage for various preventive services aimed at detecting and preventing illnesses. Examples include annual wellness visits, vaccinations, screenings for cancer, diabetes, and cardiovascular diseases.

3. Laboratory tests: Part B covers a wide range of laboratory tests, including blood tests, urine tests, and diagnostic screenings. These tests are crucial for diagnosing and monitoring various medical conditions.

4. Durable medical equipment (DME): Part B covers medically necessary DME, such as wheelchairs, walkers, oxygen equipment, and hospital beds. These items are intended for use at home and help individuals with mobility or medical needs.

5. Outpatient surgeries: Medicare Part B covers certain outpatient surgeries that are considered medically necessary. This includes procedures such as cataract surgery, colonoscopies, and joint replacements.

6. Ambulance services: Part B provides coverage for emergency and non-emergency ambulance transportation when other means of transportation could endanger the patient's health.

7. Mental health services: Part B covers a range of mental health services, including outpatient counseling, psychotherapy, and partial hospitalization programs.

8. Prescription medications: Part B covers certain medications that are administered in a healthcare setting, such as chemotherapy drugs, immunosuppressive drugs, and injectable osteoporosis drugs.

It's important to note that while Medicare Part B covers a significant portion of these services, beneficiaries may still be responsible for deductibles, coinsurance, and copayments. Additionally, some services may require prior authorization or meet specific criteria to be covered.

In conclusion, Medicare Part B is a crucial component of the Medicare program, providing coverage for outpatient medical services and supplies. It differs from Medicare Part A in terms of the services covered and the associated costs. Understanding the coverage and benefits provided by Medicare Part B is essential for individuals seeking comprehensive healthcare coverage during their retirement years.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background