Let’s talk about Medicare Part B and why it is so important to have.
How many of you have had to go to the doctor’s office for one thing or another? Did you need to have lab tests? X-Rays? Ultrasounds? MRI? Special testing of some sort? Have you been to an Urgent Care for an upper respiratory infection, a belly ache, or an injury? Did you have to pay out-of-pocket? Was it a big ole chunk of change?
Medicare Part B is your outpatient services payment method. If you do not have Part B your doctor visits, lab work, Imaging services (X-rays, MRIs, Ultrasounds, CT scans), urgent care, anything that does not occur as an in-patient in an acute care setting will not be covered. Have you ever looked at the charges for some of these services? You would have to pay for those services plus. In the case of imaging services, you have to pay for the services of the doctor that reads those films.
If you need outpatient surgery, you have the cost of the surgeon, the anesthesiologist and the anesthesia, the operating room and recovery room rent, and supplies, medications, nursing services, discharger planners, and who knows what else.
It’s true. If you do not have Medicare B, you will have to pay for it all out-of-pocket. Yes. You can claim it for a deduction on your income taxes but, goodness. I do not have that kind of reserve to spend on medical care.
If you do? Good on ya!
Personally? I would rather pay the monthly premium for Medicare B. At the time of this posting, it is $170.10 and comes directly out of your Social Security check. (Yeah. Recently We got a raise in our Social Security check and they turned around and raised the cost of Medicare Part B. I think we ended up getting an extra $4.00 a month.)
Twelve months of premiums ($2041.oo) is less than I would have had to pay for the MRIs I had a few months ago. Just the MRIs came to over $2400. I have had to have blood work and ultrasounds and doctor visits, not to mention COVID testing, vaccines, flu shots and a host of other medical needs that some people our age and in good health don’t even think about until something happens. You can use that much in just wellness check-ups! Do you need a CPAP? Medicare B.
Yes. I am not a youngster describing what they think people go through. I am almost 70 years of age, and I was a Registered Nurse for 40 years before I retired. I speak from experience and have done my homework. I have worked in acute care hospitals and Long Term Care (SNFs). I have been involved in the billing parts of both.
Medicare Part B is also a requirement if you have Tricare for Life (thank you all for your service!). You must be signed up for Medicare Part B for your Tricare for Life to activate once you begin using Medicare. I have been told that this combination is the Gold Standard of insurance coverage for those of us in our golden years.
I am not sure which ones, but some Medicare supplements also require that you have Medicare Part B. My advice is to consult with a Medicare advisor or maybe two or three. Sometimes, the stories (or advertisement pitches these people give you might vary slightly from person to person. Do your own homework!
If you decide on a commercial Medicare and have Tricare for Life, please be careful. Some supplements will mess up the coverage you have under Tricare for Life completely.
But my point in this post is that Medicare B is important. It covers your doctor visits and all your lab work and imaging. The responsibility on your part? Make sure that when you must get these tests, the doctor has given the right diagnosis code on the lab or imaging request. (There’s that phrase again: diagnosis code)
Diagnosis Code is a set of numbers, or combination of numbers and letters, that tells your insurance why you must have the test he/she is requesting for you. When the lab or imaging bills Medicare (or any insurance) and that request does not jive with the diagnosis code, the bill might get rejected and the lab will bill you for the test.
When the doctor determines that you need a test, ask him/her to review all the diagnosis codes on your chart and make sure it is an approved test for that diagnosis. Confusing, right? We, as patients, need to be proactive to avoid unnecessary tests and we need to make sure what we need gets paid for by the insurance we pay for. (Personally, I think it is a way for insurance companies to deny claims or delay payment. But that is probably my conspiracy theorist brain slipping into the conversation.)
Long story short, Medicare B pays for outpatient needs (if they right code is given). Most of our care is now given on an outpatient basis. Gone are the days of inpatient hospitalization for “tests”. You need Medicare B.
The only time you probably don’t neeeed need, it is if you have other coverage from a spouse that is still working, and your spouse’s work insurance covers you. That said, if you decline Medicare B and later decide you want it, there is often a penalty involved. That penalty is not a one-time payment. It is attached to your premium forever.
I hope I haven’t confused you too badly. My goal is to get your attention and convince you to do your homework.
Bite the bullet and sign up for Medicare Part B. You may be healthy and do everything you can to stay that way but ya never know! An illness might catch you. Flu season is upon us. We just went through a pandemic. Most people were treated as outpatients…Medicare B makes those outpatient payments.
And Another thing! There is still a copay if you don’t have a supplement to cover that. Medicare coverage is only about 80% of the approved charges. By “approved charges” I mean that Medicare has a limit on the prices providers can charge.
Example: If the bill is $2400 and Medicare only approves a price tag of $1900, they will cover 80% of that $1900 and the rest goes to you. They will pay $1520, and you get billed for $580.
If you are lucky (and some doctors’ offices will do this), your doctor will “accept Medicare assignment”. This means they accept whatever Medicare pays them and the doctors do not charge for the balance. But many do bill you for the balance. Check the financial agreement you sign at the doctor’s office or any medical service provider.
Please feel free to ask me or your provider any questions. You can also check out the CMS website at https://www.cms.gov/. Your Social Security office can also help.