Linda L. Kordes, Attorney At Law Official Newsletter
October 2012
Inside This Issue
Medicare Part B
Medicare Part C
Medigap
Part D
Autumn 2012 Newsletter

Over the summer, we presented a basic primer on Medicare; we now pick up the discussion with a look at Medicare Part B.

Medicare Part B

Part B covers physician services, laboratory fees, medical equipment costs and rehabilitative care. Ordinarily, the insured pays a monthly premium, which is deducted directly from her Social Security income. If the insured’s adjusted gross income exceeds the maximum amounts indicated below, then the premiums will be higher. Below is a chart which shows the relative premium costs:

 If Your Yearly Income in 2010 was:

You pay

File Individual Tax Return File Joint Tax Return

$85,000 or less

$170,000 or less

$99.90

above $85,001 up to $107,000

above $170,001 up to $214,000

$139.90

above $107,001 up to $160,000

above $214,001 up to $320,000

$199.80

above $160,001 up to $214,000

above $320,001 up to $428,000

$259.70

above $214,000

above $428,000

$319.70

Below is a chart which shows the Medicare deductibles:

Part B Services

Services

You Pay

Part B Deductible

You pay $140 per year.

Blood

In most cases, the provider gets blood from a blood bank at no charge, and you won't have to pay for it or replace it.

However, you will pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies.
If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

You pay a copayment for additional units of blood you get as an outpatient (after the first 3), and the Part B deductible applies.

Clinical Laboratory Services

You pay: $0 for Medicare-approved services.

Home Health Services

You pay: $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.

Medical and Other Services

You pay: 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy*, and durable medical equipment.

Mental Health Services

You pay: 40% of the Medicare-approved amount for most outpatient mental health care.

Other Covered Services

You pay: copayment or coinsurance amounts.

Outpatient Hospital Services

You pay: a coinsurance (for doctor services) or a copayment amount for most outpatient hospital services.

The copayment for a single service can't be more than the amount of the inpatient hospital deductible.

Physicians who accept Medicare payments for medical services provided are said to “accept assignment.” The insured still would be responsible to pay any deductibles and copayments, but Medicare would pay the rest. A physician is not required to accept assignment, and if she does not, then the insured would be responsible for any deductibles, copayment and the difference between Medicare’s approved fee and the physician’s fee.

Medicare Part C

Part C, or Medicare Advantage, is managed care, like health maintenance organization plans (HMO) or preferred provider organization plans (PPO,) which is offered by private health insurance companies that are approved by Medicare. The plan includes coverage of Medicare Parts A and B, plus additional coverage for prescription drugs, dental services, vision and hearing care.

In fact, your insurance company is a private one, but Medicare pays your premium to the plan, monthly. Ordinarily, one must obtain medical services within the network, so if you have a favorite doctor, you may not be able to obtain coverage when you see him. In addition, a referral is ordinarily required in order to see a specialist.

Medigap

Basically, Medigap plans supplement basic insurance coverage that would not be covered (hence the term, “gap”) by Parts A and B, except for long term care. There are fourteen different types of policies, at present, and each is designed to supplement different gaps in Medicare coverage. Some offer additional coverage for copayments or deductibles, foreign health care and home care. Each is designated alphabetically, specifically, A through N. One must be a careful and savvy consumer in order to obtain-and when to obtain is very important-the best value for one’s needs.

Part D

Part D is prescription drug coverage which has premiums, deductibles, copayments and gaps in coverage. Anyone interested should research to make a determination that Part D is cost effective for his needs. Since it is expensive, and on 60 days notice, one can be notified that his drug is no longer covered, we are reticent to recommend participation, except in very limited cases. Here’s a case where one must do his homework.

The above charts were provided through the courtesy of www.medicare.gov.

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