The medical insurance program is designed to help pay the bills for doctors' services and for a number of other medical costs not covered by the hospital insurance program.
The medical insurance program is voluntary, but eligible persons who wish to participate pay a monthly premium. For persons who are receiving railroad retirement benefits (including those also in receipt of social security benefits), the monthly premium is deducted from their railroad retirement checks; others make payments or, in some cases, have their premiums paid under a State assistance program.
The medical insurance plan helps cover physicians' services, outpatient medical and surgical services, and many other medical and health services in and out of medical institutions. It also helps cover some preventive services.
There is an annual deductible for Part B services ($183 in 2017). After the deductible is paid, Medicare will generally pay 80 percent of the approved charges for covered services during the rest of the year; the beneficiary is responsible for paying the remaining 20 percent of the cost.
Medicare provides basic protection against the high cost of illness, but it will not pay all health care expenses. Some of the services and supplies Medicare cannot pay for are custodial care, such as help with bathing, eating, and taking medicine; dentures and routine dental care; most eyeglasses, hearing aids and routine examinations to prescribe or fit them, and long-term care (nursing homes).
| WHAT MEDICARE PART B COVERS |
|---|
| Medical and Other Services : Medically-necessary doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment are usually covered, if ordered from a Medicare-approved provider. |
| Clinical Laboratory Services: Blood tests, urinalysis, and some screening tests can be covered. |
| Home Health Care Services: This is limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language therapy ordered by a doctor, and some other services. |
| Outpatient Hospital Services: This includes hospital services and supplies received as an outpatient as part of a doctor's care. |
| Blood: Part B helps pay for blood as an outpatient or as part of a Part B covered service. |
| Preventive Services: These include bone mass measurements, cardiovascular screening, colorectal cancer screening, diabetes services, glaucoma testing, screening mammograms, Pap test and pelvic examination, prostate cancer screening, some shots (Flu, Pneumococcal, and Hepatitis B), and a one-time Welcome to Medicare physical examination. |
Many other services are covered
For more information on specific services available, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.
Medical insurance generally does not pay for services outside the United States. There are rare emergency cases where medical insurance can pay for care in Canada or Mexico.
Financing
Part B medical insurance is paid for by premiums from persons who enroll in the program and by Federal general revenue funds. The standard premium rate for new enrollees in 2017 is $134. However, most Medicare beneficiaries will not pay this amount. By law, Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living adjustment for social security (railroad retirement tier I) benefits.
Since that adjustment is 0.3 percent in 2017, about 70 percent of Medicare beneficiaries will see only a slight increase in their Part B premiums. The higher premium amount will apply to new enrollees in the program, and certain beneficiaries will continue to pay higher premiums based on their modified adjusted gross income.
Monthly premiums for some beneficiaries are greater, depending on a beneficiary's or married couple's modified adjusted gross income. The income-related Part B premiums ($134 plus the monthly adjustment amount) for 2017 are $187.50, $267.90, $348.30, or $428.60, depending on how much an individual beneficiary's modified adjusted gross income exceeds $85,000 (or a married couple's income exceeds $170,000). Only beneficiaries whose modified adjusted gross income exceeds $214,000 (or $428,000 for a married couple) pay the highest premium. Some individuals also pay premium surcharges because they enrolled late for Part B.