Medical Insurance cover several medical services and items

Medicare’s Part B (medical insurance) covers medical services other than hospitalization. It helps pay doctors and outpatient hospital care. Part B also pays for some other medical services that Part A doesn’t cover, including the following:

- Physical and occupational therapy

- Flu, pneumonia, and hepatitis B shots

- X rays and laboratory tests

- Mammograms, and Pap smears to screen for cervical cancer

- Outpatient mental health services

- Artificial limbs and eyes

- Durable medical equipment, including wheelchairs, walkers, hospital beds, and oxygen equipment prescribed for home use by a doctor

- Kidney dialysis and kidney transplants; under limited circumstances, heart, lung, and liver transplants in a Medicare-approved facility

- Medical supplies and items such as ostomy bags, surgical dressings, splints, and casts

Medicare Part B doesn’t cover several medical services and items, such as routine physicals, most dental care, dentures, hearing aids, and most prescription drugs. Part B covers eyeglasses only for corrective lenses after cataract surgery. Members of Medicare Part B pay a monthly premium of $45.50. If you enrolled late (see previous explanation), your premium goes up by 10 percent for each 12-month period you could have been enrolled but weren’t. Part B’s members pay an annual deductible of $100. After you pay the $100 deductible, Medicare pays 80 percent of the approved charges for covered services for the rest of the year. (An approved charge is the amount that Medicare decides the service is worth. This amount may differ from the actual amount on your bill.) You pay the balance of the hospital’s charges. Medicare pays 50 percent for approved outpatient mental health services, and members pay the balance. Members also pay for all charges for services and supplies that Medicare doesn’t cover.

Medicare + Choice (Medicare Plus Choice, Medicare Part C)

The Balanced Budget Act of 1997 changed the Medicare program. This law, effective in 1999, includes Medicare + Choice, which expands the Medicare health plan options to include a broader range of plans. You can choose between Original Medicare a fee-for-service program available to all Medicare beneficiaries and a managed care organization that has a contract with Medicare. Medicare HMOs are available in many parts of the United States. With Medicare + Choice, Medicare pays the managed care organization to provide medical services to you. In addition, Medicare + Choice offers some preventive care services to help you stay healthy, at no extra cost.

In many ways, the Medicare + Choice managed care plan is like the Original Medicare with an attached Medigap policy (see the next section). Some of these Medicare managed care plans offer services that a Medigap policy doesn’t cover. The downside is that generally you can see only doctors and hospitals that belong to the HMO.

To enroll in Medicare + Choice health plan options:

- You must have Medicare Parts A and B.

- You must not have end-stage renal disease.

Whether you remain in the Original Medicare plan or choose a Medicare HMO, you’re still in the Medicare program and will receive all the Medicare covered services.

Medigap and Medicare SELECT

Original Medicare doesn’t pay every medical expense you incur. So, you may want to consider private supplemental insurance policies, such as Medigap policies or Medicare SELECT, to add the extra coverage you need.