Tag Archives: Medicare Benefits

Medicare Part B Benefits

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Part B Medicare Benefits cover a variety of procedures that are not covered under Part A Benefits. Like other Medicare Benefits, those who are working are able to put off enrolling for Part B Benefits, which are optional, however those who are not working and do not enroll will face a 10% increase in premiums each year.

To Enroll in Medicare, including Part B Benefits, you can visit their site here.

While Part C is used to cover prescription medicine, Part B will cover medication that is given by a doctor. It also covers some doctors visits, x-rays, blood tests, chemotherapy, ambulance transportation, and a number of other outpatient treatments, such as vaccination for the flu.


Durable Medical Equipment

One of the most important parts of Part B Benefits, however, is the coverage of Durable Medical Equipment. Durable Medical Equipment refers to a number of different types of home medical equipment, such as hospital beds and wheelchairs, as well as things like eye glasses, oxygen equipment, and prosthetics.

In most cases, Medicare will cover 80% of the cost of the equipment, with the insured being responsible for the remaining 20%. It is almost always necessary to have a doctors prescription and certain types of equipment will also require a Certificate of Medical Necessity, which is simply a much more detailed prescription that outlines the specific conditions the patient has. Certain equipment will have some extra requirements that the patient must meet, such as someone who wants to have their mobility scooter covered would need to use it all of the time, both at home and away, and not merely when away from home.

While the majority of medical equipment covered under Part B Benefits is covered up to 80%, this is not the case with all types. Lift Chairs, which are basically recliners that act as a standing aid, are one example, as they are only partially covered. They also require a Certificate of Medical Necessity, which among other things, requires that the patient can not stand from any chair in their home. Usually Medicare will be reimbursed for about $300, which covers the cost of the lifting mechanism, but the entire chair is not covered. Getting reimbursement is not always easy either.

Other items, specifically those that involve home modification are not usually covered under Medicare Part B. For example, widening the doorways for a wheelchair user or installing an elevator would not be covered.

Cost of Part B Benefits

A monthly premium is required for those wishing to use Part B Benefits, which is usually around $100. However, since 2007, the premium is also based off of income and whether the insured is married, with a higher income meaning a higher premium and can be as high as $300.

In addition to a monthly premium, the patient must also pay a yearly deductible if they use these benefits, which was around $130 in 2009. There is also a copay required for most items, which is usually 20% of the cost of the item, with Medicare paying the other 80%. However, as stated above, some items, like lift chairs Medicare, are only partially covered under Medicare. However, blood work and other laboratory services are often covered completely. A 15% surcharge is added if the physician is not certified by Medicare.

Medicare Part C Benefits: Medicare Advantage Plans

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Medicare is a socialized insurance program that is funded by the Federal Government and was first established during the 1960’s. Originally, Medicare included two Parts, Part A and Part B, and was both funded and administered over solely by the Government. However, beginning in 1997, a new part of Medicare was added that allowed those on Medicare to opt to use a private insurance plan, instead of the traditional federally run plans. These plans are called Medicare Advantage Plans and are under Part C of Medicare Benefits.

What Are Medicare Advantage Plans?

The idea behind Medicare Advantage Plans is that the actual plan itself is run by private insurance companies. The plans are still funded by the Federal Government, but are actually administered over by the private health industry. Medicare Advantage(MA) Plans, were added onto Medicare as part of the Balanced Budget Act of 1997 and in 2003, Prescription Drug Coverage was added as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Like traditional Medicare Plans, such as Part A Benefits, the insured usually has to pay a premium when using an MA plan. MA plans are also required to cover anything that regular Medicare would, but are given a good deal of leeway in how they implement their insurance program. So, for example, an MMA plan is required to help cover the cost of a doctors visit, but they may require a higher co-pay than traditional Medicare.

Many Medicare Advantage Plans will also cover some things that traditional Medicare does not, in an effort for the Private Insurance Companies to get people to use their programs.

Dangers of Using Medicare Advantage Plans

Since the private insurance companies run MA plans and are allowed to make some changes to what they charge or how they cover certain things, it is important to be very careful when choosing a plan. It is important to compare the benefits and costs of the plans to traditional Medicare, taking into account the needs of the insured. It is also important to compare the different Medicare Advantage Plans available, as they can differ too.

Again, because MA Plans are run by Private Insurance instead of the Government, many patients find that they have difficulty getting items covered and must fight the insurance companies, who are, after-all, out to make a profit. Each year, a great deal of those who signed up for MA plans, wooed by the extra perks, like dental coverage, decide to switch to the Federally run programs, with about a third of these people citing problems getting coverage through the private insurance companies.

Cost to the Taxpayers

In addition to many finding that the for-profit Medicare Advantage Plans do not provide adequate coverage and making claims is often met with resistance from the private insurance industry, these plans are also much more expensive to the taxpayers.

On average during 2005, these plans cost the taxpayers about 12.5% more than traditional Medicare, with the private insurance companies usually earning at least 6% profit.

When you take into account the fact that so many people are dissatisfied with MA plans and the added cost to tax payers, it makes it very hard to support allowing Private Insurance to become involved with Medicare. However, as can be seen from the current health care debate, Private Insurance Lobbyists have a very deep hold on the Senate and the President.