Part B. Doctor, Cancer, Surgery, supplemental insurance Flashcards Preview

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Flashcards in Part B. Doctor, Cancer, Surgery, supplemental insurance Deck (4)
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Part B:

Medicare part B is medical insurance for outpatient doctor visits.
1. Services from doctors and other healthcare providers.
2. Outpatient care.
3. Home health care.
4. Medical equipment like wheel chairs, walkers, hospital beds, and other equipment.
5. Many preventive screenings, shots or vaccines.

If you have part B, it will be on your card as “Medical”, and it will have an effective date.
Part B details are in your Medicare book PP 30-49.
To find out if Medicare covers a service not listed on these pages, go to Or call 800-633-4227.

The 2019 deductible part B was $185.
The premium is $135/mo. for part B.

After your deductible is met, you pay 20% of the Medicare approved amount of the service if the doctor accepts assignment.

You pay nothing for most covered preventive services that accept assignment.

Chemo. Medicare covers chemotherapy in a doctor office, free standing clinic, or hospital outpatient setting for people with cancer. You will pay a copayment for chemotherapy in a hospital outpatient setting. P. 33. (Confusing. Need clarification)


Supplemental insurance. P. 69.

Also called medigap policies. More fully explained in detail on P. 69.

1. Helps pay copayments, coinsurance and deductibles.
2. Policies have different letters to identify them, A through N.
3. P. 70 has a chart showing coverages.
4. I can get a better deal on choices retroactive p. 69.
5. P. 72. HT get a pamphlet further explaining HT choose a medigap policy.
6. Important facts about medigap p. 71.

Part B.

Premium for part B is $135/mo.
Deductible for part B is $185.00.

Cancer, radiation and chemotherapy is covered in part B, albeit there is a co payment in straight Medicare part B. In Medicare advantage it may be covered .


What is a Medicare health plan?

Generally a Medicare health plan is offered by a private company that contracts with Medicare to provide Medicare part a and Medicare part B insurance benefits to people who enroll in the plan this includes Medicare advantage plans.

Medicare Advantage plans must cover all of the services that original Medicare covers. However, if you’re in a Medicare advantage plan, original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some calls for clinical research studies. And all types of Medicare advantage plans, you are always covered for emergency and urgently needed care.

The plan can choose not to cover the cost of services that are not medically necessary under Medicare. If you are not sure whether a services covered, check with your provider before you get to service.

Most Medicare advantage plans offer coverage for things that are not covered by original Medicare like vision, hearing, dental and wellness programs like gym memberships. Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult daycare services, and other health related services to promote your health and wellness. Plans can also tailored your benefit package to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with the plan to see what benefits are offered and if you qualify. Most include Medicaid prescription drug coverage part D. In addition to your part B premium, you usually pay a monthly premium for the Medicare advantage plan.

In 2019, the standard part B premium amount is $135.50. In 2020, the standard part B premium will be $144.60.

If you need a service that the plan says isn’t medically necessary, you may have to pay all the cost of the service. But, you have the right to appeal the decision.

You or a provider acting on your behalf can request to see if an item or service will be covered by the plan in advance. Sometimes you must do this for the service to be covered. This is called an “organization determination”. If your plan denies coverage, the plan must tell you in writing.

You do not have to pay more than the plans usual cost sharing for a service or supply if the network provider did not get an organization determination and either of these is true.
1. the provider gave you a referred you for services or supplies that you reasonably thought would be covered.
2. The provider referred you to an out of network provider for plan covered services.