Medicare Part B
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 12/21/21
Duration: 10 Minutes
In this episode, Ben Rothering gives us information about Medicare Part B. Mr. Rothering talks about the difference between part A and part B, what part B covers, premiums, and how their cost is determined.
Transcription:
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part three of a five part series on Medicare. For anybody who's eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering.
He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. Ben it's great to have you back on. We're in part three of this five-part series. In part one, we talked about Medicare 101, enrollment particulars. In part two, we discussed Medicare part A and of course there are four parts. And today we're going to talk about part B. So let's do that. How is B different from A, or how does B supplement A? I'm going to leave it to you and your expertise.
Ben Rothering BS Education (Guest): So part B is all about your out-patient, right. So with part A it's your inpatient, when you're hospitalized, admitted to the hospital, part B is going to be all about your outpatient benefits. So it's your regular doctoring, specialist visits, therapies, durable medical equipment, preventive services. When we talked about part A, I discussed if you were hospitalized, but you were just being kept for observation versus being admitted, right? Part B is about observation.
And it also covers the ambulance services. So when you start part B, everybody's going to have a premium for part B and how they determine your premium is going to be based on how you file your taxes. And they're looking at two years prior. So, they're going to look if you filed individually, or if you filed jointly and they have brackets that break it down. Now, the part B premium, the base premium for 2021 is $148.50 and we just received the numbers for next year for 2022. The base premium is $170.10. And then again, if you find that you're in a higher bracket, you can end up paying a higher premium for your part B services.
Now, the way that is paid. There's kind of two opportunities here. If you are not receiving your social security benefits, your monthly benefits, then social security is going to bill you quarterly. You'll see bill come every quarter and that would be your part B premium broken down. If you are drawing your social security benefits, then Medicare will deduct your part B premium from your monthly benefit prior to depositing it into your account. Okay. Now, when you start part B, you have 12 months to do, what's called a welcome to Medicare visit which is like a preventive check-in with your doctor to receive some education and counseling about preventive services and check and see how you're doing.
And then every year, Medicare is going to pick up a yearly wellness visit to check in with your doctor. Now part B works a little different than part A. If you remember, when we talked about part A, it has a 60 day benefit period. Part B works on an annual deductible. So, when you go in for your first outpatient services, Medicare doesn't pay the part B deductible.
So that needs to be paid. For next year, for 2022, it's going to be $233. So once that $233 is paid, now Medicare is going to jump in and they're going to pay their 80% for any Medicare eligible covered charges. And then there's the 20% that's left over. That's typically that 80, 20 split is what I hear a lot from people that they hear the most about. Okay. Is that 80 20 split. Other benefits that go with part B, medicare is going to cover a hundred percent for covered clinical lab services, for blood tests and diagnostic services. They cover a varying amount of preventive services so things like, mammograms, Medicare will cover a mammogram a year. They'll cover your flu shot every year. They will cover a colonoscopy every 10 years. So Medicare has their schedule of how often they're going to cover these preventive services.
Now some of you might be saying, well, I went and I had my colonoscopy and my doctor said that I was at a higher risk. And so maybe I needed to have a colonoscopy every five years or maybe every three years. If that's the case and your doctors are proving that it's medically necessary to do this sooner, then Medicare may reduce those timeframes for you because of that medical necessity.
However, Medicare is not going to cover anything that exceeds the Medicare approved amount. So if you've ever seen a bill that has Medicare involved, you'll know that Medicare, they drop the prices quite a bit. So an example, I'm just making up numbers, but if you go in and you have a bill that is for $5,000, and then you see that the Medicare approved amount is $2,000.
We are now working from the $2,000, the $3000 that is no longer there, it's not on the Medicare beneficiary to have to cover. That's a contractual obligation for any place that is accepting and billing Medicare. So now Medicare covers the 80% of that 2000 and there's 20% left of that 2000. Now some things that Medicare is not going to cover would be routine dental, routine vision, routine hearing, or foot care. They don't cover anything for longterm care, like in nursing homes. Anything alternative, or homeopathic. Medicare covers things that have been put through the paces and approved.
They won't cover anything that's elective or cosmetic, no personal care. They also do not leave the country. Medicare will go anywhere in the US with you, but they will not leave the US. Prescription drug coverage. That's something that we will talk about when we discuss our part D segment and then, you know, Medicare isn't going to cover anything that is considered non-medical expenses. So like travel costs or lodging costs if you decide that you want to go get treatment somewhere, you know, find a specialist across country. They're not going to help you get there. Okay.
Host: You know, Ben, we're about halfway through our series here. You know, we had part one, we talked about enrollment and those particulars and then part A, and now we're doing part B and there's a lot to take in here and hopefully listeners are keeping up with us. Maybe now that we're halfway through here, maybe you can just quickly kind of go over the enrollment, particulars again, you know, maybe not the whole thing. Folks can go back and listen to the first episode, but just sort of the Reader's Digest version here. Just briefly what do folks need to know? I know that, you know, Medicare is folks start thinking about that before they turn 65, but I'll let you tell listeners the rest.
Ben: Something that's definitely going to help you out is going online to the social security website and getting a my social security account. It can make your life a lot easier and you're able to enroll in the comfort of your own home, right over the internet. And then most people are going to fall into the initial enrollment period or the special enrollment period. You know, the initial enrollment period is for when someone is turning 65, that's a seven month window.
The special enrollment period is if you have group coverage from you or your spouse through an employer, and you decide to retire later, then you could pick a part B at a later time and not worry about a penalty. The general enrollment period, that is where you could incur a penalty for taking Medicare later than you were supposed to and you didn't have any other credible health insurance to speak of. And then you are outside of your enrollment periods, then there's a potential that you would end up getting a penalty at that time.
Host: Got it. And if folks want to reach out to you, Ben, if they want to have a longer conversation, which would seem completely reasonable to me, just from what I've heard in the episodes that we've done so far, how can they reach you?
Ben: Absolutely. My cell phone number or my email address are the best ways to get in contact with me. My cell phone number is 608-354-3869. Or my email address is my last name, the number This email address is being protected from spambots. You need JavaScript enabled to view it. . So I'll spell it out for you. It's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's great. Well, we're going to come back and next time, we're going to talk about part C. You know, originally, when I envisioned doing these episodes with you, I was like, well, why don't we do them all at the same time? Now I understand completely. There's just too much information to do all of these and really better to separate these things out.
So we've done A and B. Next time, we'll talk about Medicare part C. I'll talk to you then. Thanks, Ben.
Ben: Thank you. Bye-bye.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts.
I'm Scott Webb. Stay safe and be well.
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part three of a five part series on Medicare. For anybody who's eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering.
He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. Ben it's great to have you back on. We're in part three of this five-part series. In part one, we talked about Medicare 101, enrollment particulars. In part two, we discussed Medicare part A and of course there are four parts. And today we're going to talk about part B. So let's do that. How is B different from A, or how does B supplement A? I'm going to leave it to you and your expertise.
Ben Rothering BS Education (Guest): So part B is all about your out-patient, right. So with part A it's your inpatient, when you're hospitalized, admitted to the hospital, part B is going to be all about your outpatient benefits. So it's your regular doctoring, specialist visits, therapies, durable medical equipment, preventive services. When we talked about part A, I discussed if you were hospitalized, but you were just being kept for observation versus being admitted, right? Part B is about observation.
And it also covers the ambulance services. So when you start part B, everybody's going to have a premium for part B and how they determine your premium is going to be based on how you file your taxes. And they're looking at two years prior. So, they're going to look if you filed individually, or if you filed jointly and they have brackets that break it down. Now, the part B premium, the base premium for 2021 is $148.50 and we just received the numbers for next year for 2022. The base premium is $170.10. And then again, if you find that you're in a higher bracket, you can end up paying a higher premium for your part B services.
Now, the way that is paid. There's kind of two opportunities here. If you are not receiving your social security benefits, your monthly benefits, then social security is going to bill you quarterly. You'll see bill come every quarter and that would be your part B premium broken down. If you are drawing your social security benefits, then Medicare will deduct your part B premium from your monthly benefit prior to depositing it into your account. Okay. Now, when you start part B, you have 12 months to do, what's called a welcome to Medicare visit which is like a preventive check-in with your doctor to receive some education and counseling about preventive services and check and see how you're doing.
And then every year, Medicare is going to pick up a yearly wellness visit to check in with your doctor. Now part B works a little different than part A. If you remember, when we talked about part A, it has a 60 day benefit period. Part B works on an annual deductible. So, when you go in for your first outpatient services, Medicare doesn't pay the part B deductible.
So that needs to be paid. For next year, for 2022, it's going to be $233. So once that $233 is paid, now Medicare is going to jump in and they're going to pay their 80% for any Medicare eligible covered charges. And then there's the 20% that's left over. That's typically that 80, 20 split is what I hear a lot from people that they hear the most about. Okay. Is that 80 20 split. Other benefits that go with part B, medicare is going to cover a hundred percent for covered clinical lab services, for blood tests and diagnostic services. They cover a varying amount of preventive services so things like, mammograms, Medicare will cover a mammogram a year. They'll cover your flu shot every year. They will cover a colonoscopy every 10 years. So Medicare has their schedule of how often they're going to cover these preventive services.
Now some of you might be saying, well, I went and I had my colonoscopy and my doctor said that I was at a higher risk. And so maybe I needed to have a colonoscopy every five years or maybe every three years. If that's the case and your doctors are proving that it's medically necessary to do this sooner, then Medicare may reduce those timeframes for you because of that medical necessity.
However, Medicare is not going to cover anything that exceeds the Medicare approved amount. So if you've ever seen a bill that has Medicare involved, you'll know that Medicare, they drop the prices quite a bit. So an example, I'm just making up numbers, but if you go in and you have a bill that is for $5,000, and then you see that the Medicare approved amount is $2,000.
We are now working from the $2,000, the $3000 that is no longer there, it's not on the Medicare beneficiary to have to cover. That's a contractual obligation for any place that is accepting and billing Medicare. So now Medicare covers the 80% of that 2000 and there's 20% left of that 2000. Now some things that Medicare is not going to cover would be routine dental, routine vision, routine hearing, or foot care. They don't cover anything for longterm care, like in nursing homes. Anything alternative, or homeopathic. Medicare covers things that have been put through the paces and approved.
They won't cover anything that's elective or cosmetic, no personal care. They also do not leave the country. Medicare will go anywhere in the US with you, but they will not leave the US. Prescription drug coverage. That's something that we will talk about when we discuss our part D segment and then, you know, Medicare isn't going to cover anything that is considered non-medical expenses. So like travel costs or lodging costs if you decide that you want to go get treatment somewhere, you know, find a specialist across country. They're not going to help you get there. Okay.
Host: You know, Ben, we're about halfway through our series here. You know, we had part one, we talked about enrollment and those particulars and then part A, and now we're doing part B and there's a lot to take in here and hopefully listeners are keeping up with us. Maybe now that we're halfway through here, maybe you can just quickly kind of go over the enrollment, particulars again, you know, maybe not the whole thing. Folks can go back and listen to the first episode, but just sort of the Reader's Digest version here. Just briefly what do folks need to know? I know that, you know, Medicare is folks start thinking about that before they turn 65, but I'll let you tell listeners the rest.
Ben: Something that's definitely going to help you out is going online to the social security website and getting a my social security account. It can make your life a lot easier and you're able to enroll in the comfort of your own home, right over the internet. And then most people are going to fall into the initial enrollment period or the special enrollment period. You know, the initial enrollment period is for when someone is turning 65, that's a seven month window.
The special enrollment period is if you have group coverage from you or your spouse through an employer, and you decide to retire later, then you could pick a part B at a later time and not worry about a penalty. The general enrollment period, that is where you could incur a penalty for taking Medicare later than you were supposed to and you didn't have any other credible health insurance to speak of. And then you are outside of your enrollment periods, then there's a potential that you would end up getting a penalty at that time.
Host: Got it. And if folks want to reach out to you, Ben, if they want to have a longer conversation, which would seem completely reasonable to me, just from what I've heard in the episodes that we've done so far, how can they reach you?
Ben: Absolutely. My cell phone number or my email address are the best ways to get in contact with me. My cell phone number is 608-354-3869. Or my email address is my last name, the number This email address is being protected from spambots. You need JavaScript enabled to view it. . So I'll spell it out for you. It's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's great. Well, we're going to come back and next time, we're going to talk about part C. You know, originally, when I envisioned doing these episodes with you, I was like, well, why don't we do them all at the same time? Now I understand completely. There's just too much information to do all of these and really better to separate these things out.
So we've done A and B. Next time, we'll talk about Medicare part C. I'll talk to you then. Thanks, Ben.
Ben: Thank you. Bye-bye.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts.
I'm Scott Webb. Stay safe and be well.
