Medicare Part B-Coverage for Out of Hospital Expenses

In the United States, qualifying individuals are eligible for a federal health insurance plan called Medicare. This program was conceived as a way to help qualifying individuals cover costs incurred form medical expenditures

Individuals who are at least 65 years of age have certain other illnesses or disabilities or who have serious kidney disease are eligible for coverage under the program. The program is comprised of four parts that cover different aspects of medical care. Part A covers hospitalization and related care, Part B covers outpatient type services, Part C has to do with Advantage Plans and Part D is prescription drug coverage.

Medicare Part B is the portion of the program that provides coverage for outpatient hospital care, physician visits and related services usually covered under traditional private plans.

Care that is not in patient usually falls under this part of the program. Some covered services include physician and surgeon fees, clinical laboratory services, ambulance services and other outpatient services. As a general rule, only services deemed medically necessary will be covered.

For example, things like experimental procedures, chiropractic care or cosmetic services are not covered services. Some preventive services such as bone density measurements, pap smears and breast cancer screenings for women and prostate cancer screenings for men are covered.

Unlike Part A, there are premiums involved in Medicare Part B. Funding for the program is accomplished by premiums paid by enrollees and money from the federal government. Those enrolled in this part of the program are also responsible for a yearly deductible and a co pay at the time services are rendered.

The monthly premium is deducted from enrollees’ Social Security checks. The premiums are typically raised each year, so it is wise to enroll as soon as possible when you become eligible. After a participant meets their yearly deductible, coverage will equal 80% of the “reasonable charge” for services covered under the program.

Much of the health care that we need as we age is in the form of doctor visits, laboratory tests, screenings for conditions and diseases and other outpatient services. Medicare Part B is optional, supplemental health insurance designed to fill some of the holes in coverage that exist when the hospital expense related Part A stands alone.

This federal health insurance program makes it possible for people age 65and over and those with other qualifying health issues to have access to medical care.