Module 1 - Overview of Medicare Program Basics: Choices, Eligibility, and Benefits - PART B

Question 1

Original Medicare, Part B, generally covers 8 services:

Answer 1

1. Physician and other health care professional services
2. Outpatient hospital services
3. Clinical lab and diagnostic tests, such as X-rays, MRIs, CT scans
4. Durable medical equipment
5. Home health care that is not covered under Part A (because the individual was not in a hospital for SNF or has exceeded 100 days)
6. Physical and occupational therapy
7. Ambulatory surgical center services
8. Chemotherapy provided on an outpatient basis

Question 2

Medicare Part B - 9 Other Items and Services:

Answer 2

1. Ambulance services
2. Chiropractic servicers - for limited situations
3. Opioid use disorder treatment
4. E-visits
5. Diabetic supplies
6. Kidney dialysis
7. Outpatient mental health care (limits apply)
8. Certain telehealth services (During the COVID-19 public health emergency and for five months after telehealth services are covered in any location in the U.S. including the home).
9. Continuous Positive Airway Pressure

Question 3

Medicare Part B - Original Medicare Cost Sharing
($226 annual deductible)

Answer 3

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

• A @226 annual deductible. The deductible does not apply to certain Part B-covered preventive services.

Question 4

Medicare Part B - Original Medicare Cost Sharing
(After the $226 annual deductible is satisfied/paid)

Answer 4

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

After the deductible is satisfied/paid, beneficiaries typically pay 20% of the Medicare-approved cost for Part B covered services.

Question 5

Medicare Part B Benefits - Preventive Services and Screenings:

Answer 5

Beneficiaries covered under Original Medicare Advantage plans will have no cost-sharing for most preventive services.

Question 6

What are the 8 Medicare Part B Preventive Services:

Answer 6

1. One-time “Welcome to Medicare” physical
2. Annual wellness visit after 12 months enrolled in Part B and annually thereafter
3. Vaccines - pneumococcal, hepatitis B, annual flue shot, COVID (including boosters) (Note: certain vaccines such as the shingles shot are covered under Part D, not Part B)
4. Bone mass measurement - every 24 months for certain conditions or meets certain criteria
5. Pap test and pelvic exam - every 24 months for all women; every 12 months for those at risk
6. Diabetes self-management training - for persons with diabetes
7. Smoking and tobacco-use cessation counseling - for any illness related to tobacco use
8. Glaucoma testing - once per year for those at high risk

Question 7

What are the 9 services that are NOT covered by Original Medicare:

Answer 7

1. Health care while traveling outside the U.S.
2. Cosmetic surgery
3. Custodial/long-term care
4. Outpatient prescription drugs (this is covered under Part D)
5. Most dental care (however, Original Medicare may pay for some dental services before, or as part of, certain related medical procedures (like before certain cardiac or organ transplant procedures.
6. Massage Therapy
7. Eye exams for glasses
8. Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
9. Covered items or services provided by a doctor or other provider who has opted out of Medicare (except in the case of an emergency or urgent need)