This is the second part of a three-part series on Medicare.

HE SAYS:

Unlike Part A, Medicare, Part B is elective and is not free.  You pay a monthly premium which may change on January 1st of each year.   The monthly premium for 2011 is $110.50 unless your annual income is over $85,000 for individuals or $170,000 for couples.   The monthly premium may be even higher if you did not choose Part B when you first became eligible at age 65.   In fact, the cost of Part B may go up 10% for each twelve month period that you could have had Part B but did not sign up for it.

You can sign up for Part B any time during a 7 month period that begins 3 months before you turn 65.   If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payments.   If you do not receive any of these retirement payments, Medicare will bill you for the premiums.

Medicare, Part B, helps pay for Doctor’s services; outpatient medical and surgical services and supplies; diagnostic tests; ambulatory surgery center facility fees for approved procedures; durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers; and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care, when these services are medically necessary.  Medicare, Part B, does not pay for prescription drugs, cosmetic surgery, and routine physical exams.

You may go to any Doctor or hospital that accepts Medicare and a fee is charged each time you receive a service.   Medicare pays its portion of the fee and you pay the balance of the fee.   If you go to a Doctor or hospital that does not accept Medicare, you will have to pay the full charge and Medicare will send you its share of the costs.

The portion paid by Medicare, Part B, is measured by a Benefit Period which is based on a calendar year.  The portion not paid by Medicare, Part B, is paid by you as a deductible.   The Medicare, Part B, deductibles for 2011 are as follows:

1.  Medical and other Services: Once each calendar year, you pay a deductible of $162.00 and, then, 20% of all Medicare approved amounts after the deductible.

2.  Outpatient Hospital Services: You pay a co-insurance or fixed co-payment which may vary according to the service, but never higher than the Part A deductible of $1,132.00.

3.  Home Health Care: You pay nothing for Medicare approved services, if you meet certain conditions established by Medicare.

4.  Durable Medical Equipment: You pay 20% of the Medicare approved amount.

5.  Outpatient physical and occupational therapy: You pay 20% of all costs.

6.  Most Diagnostic Tests: You pay 20% of the cost after the $162.00 deductible.

One important right you have with both Medicare, Part A and Part B, is that you can obtain emergency care when and where you need it.   You do not need approval from your health plan.   If you think your health is in serious danger because you have severe pain, a bad injury, sudden illness, or an illness quickly gets worse, you can get emergency care anywhere in the United States.

The next installment will be about Medicare, Part C and Part D.

WHAT DO YOU SAY?