NUR 2407 Assignment Medication Olympics part B

What exactly is Medicare Part B?

Medicare Part B covers a wide range of healthcare services that can be broken down into two categories: medically necessary services and preventive services.

• Medically necessary services. These are services and supplies you need to diagnose and treat your medical condition. Services include doctor visits, ambulance transport, outpatient therapy, and mental health support. Supplies include durable medical equipment (DME) such as blood sugar meters, oxygen equipment, and wheelchairs, to name a few.

• Preventive services. These are services to prevent illness or diagnose illness at an early stage when treatment is most beneficial. Mammograms, colonoscopies, prostate cancer screenings and bone density screenings are some of the preventive services covered in Part B. Another example is immunizations, including the COVID-19 vaccine. (The COVID-19 vaccine is free to everyone who wants one during the public health emergency, but Part B pays for those on Medicare who receive it.)

NUR 2407 Assignment Medication Olympics part B

What is the difference between Medicare Part A and Part B?

Medicare Part A covers different medical services than Part B, and it’s important to understand the differences. Part A covers (with limitations):

• Inpatient hospital stays

• Inpatient psychiatric hospital stays

• Skilled nursing facility (SNF) care

• Home health care

• Hospice care

Part A and Part B also differ in their coverage for dialysis services. Part A only covers dialysis treatment during hospital stays. Part B covers:

• Training for you and your caregiver to learn how to use the dialysis machine and supplies at home

• Home support from a trained professional to help you with your at-home treatments

• Outpatient treatment at a Medicare-approved facility

• Most drugs for at-home or outpatient dialysis

What kind of drugs are covered under Medicare Part B vs. Parts A and D?

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Part B drug coverage is typically for medications you receive in a doctor’s office or outpatient setting. Coverage includes:

• Drugs used with medical equipment like an infusion pump or a nebulizer

• Antigens

• Injectable osteoporosis drugs

• Erythropoiesis-stimulating agents if you have end-stage renal disease (ESRD) or anemia related to other conditions

• Oral ESRD drugs

• Blood-clotting factors if you have hemophilia

• Injectable and infused drugs

• Intravenous and tube feeding

• At-home Intravenous Immune Globulin (IVIG)

• Vaccines for flu, pneumococcal pneumonia, Hepatitis B, and more

• Transplant or immunosuppressive drugs if Medicare helped pay for your organ transplant

Most of the time you can expect to pay 20% of the Medicare-approved amount for Part B-covered drugs you receive in a doctor’s office or pharmacy. This is after you’ve paid your Part B deductible.

Part A covers drugs, medical supplies, and medical equipment used during an inpatient hospital stay or at a skilled nursing facility.

Part D covers many drugs you would fill at a pharmacy, including brand-name and generic prescriptions. Check your Part D formulary — the list of covered drugs — for medications that Part B doesn’t cover, unless you have comparable drug coverage from another source.

What premiums, copays, and deductibles do you need to pay for Medicare Part B?

Monthly premiums

Your Part B monthly premium is deducted from your Social Security or Railroad Retirement Board benefits. If you don’t get benefits, you’ll get a bill every three months that you can pay online, directly from your checking or savings account, or by mail.

The standard monthly premium in 2021 for Medicare Part B is $148.50 per month. The Centers for Medicare & Medicaid Services says most people fall into this category, where individual earners report 2019 income of $88,000 or less and joint filers report $176,000 or less. However, what you pay in Part B premiums depends on the modified adjusted gross income shown on your tax return. Those who earn more pay more on a graduated scale.

There are five payment levels above the standard monthly premium that max out at $504.90 per month for the wealthiest tax filers.

Deductible and coinsurance

Unlike Medicare Part B premiums, the Part B deductible isn’t adjusted according to your income. For 2021, your Medicare Part B deductible is $203. After you meet your deductible, you will typically pay 20% of the Medicare-approved amount for:

• Most doctor visits

• Services during hospital stays

• Outpatient therapy

• Durable medical equipment (DME) such as blood sugar meters, oxygen equipment, and walkers

What if I have a Medicare Advantage Plan?

Medicare Advantage plans — also known as Medicare Part C — are plans that combine Medicare Parts A, B, and usually D. They are administered by private health insurance companies and often come with extras such as dental and vision benefits or gym memberships. But unlike original Medicare, Medicare Advantage plans typically require members to use limited networks of doctors and hospitals. A variety of different Medicare Advantage (MA) plans are on the market.

Medicare Advantage plans must cover everything that original Medicare covers, but they may have different rules. Check with your plan about rules, costs and restrictions. You may still have to pay your monthly Part B premium if you have a Medicare Advantage plan, in addition to your monthly MA premium, depending on your plan rules.

When do you typically sign up for Medicare Part B?

Failing to apply for Medicare Part B when you’re eligible could cost you in late fees. Pay attention to the Medicare Part B enrollment periods listed below to avoid penalties.

When you first sign up for Medicare

When you first become eligible for Medicare at age 65, you have a 7-month Initial Enrollment Period to apply for Part B. Your eligibility for enrollment starts three months before the month you turn 65. It includes the month of your 65th birthday and the three months following your birth month.

If you sign up for Part B after your 7-month enrollment period, you’ll be charged a monthly late penalty of 10% for each 12-month period you could have had Part B. The longer you go without Part B, the higher the penalty. However, you will not pay the penalty if you meet certain special enrollment period requirements.

Special enrollment periods

Your special enrollment period starts when one of the following applies:

• You sign up while you’re still enrolled in a group health plan (for example, through an employer), or

• During the first full month when you’re no longer covered by a group health plan, whichever happens first.

From January 1 to March 31 each year

You can sign up during general enrollment from January 1 to March 31 if:

• You didn’t sign up when you were first eligible.

• You cancelled Part B without having other insurance but would like to re-enroll.

• You didn’t enroll for Part B within eight months after your employer or union health plan ended or when you stopped working, whichever happened first.

Regardless, if you apply for Part B between January 1 and March 31, your coverage will start on July 1.

Where can I go if I have questions about Medicare Part B?

In addition to visiting Medicare.gov, here are a few other sources for Medicare information:

• Medicare Rights Center is a nonprofit organization that helps people with Medicare understand their rights and how the system works. Call their free national hotline at 800-333-4114 for help or visit MedicareInteractive.org.

• Center for Medicare Advocacy is a nonprofit advocacy organization that promotes health equity and quality healthcare for people on Medicare. They offer free resources like self-help checklists to help you appeal a Medicare denial.

• State Health Insurance Assistance Programs (SHIP) offer free, unbiased counseling and assistance programs at the state level. To find your state SHIP office, call 877-839-2675.