By now, you know that Medicare Part B provides outpatient/medical insurance. But are you familiar with the details?
We’ve put together a summary of Part B covered-services and rules. Most of these types of services are pretty self-explanatory. But for the sake of simplicity, we’ll explain them clearly.
First, Medicare Part B covers medically necessary services you get from a licensed health professional. Examples of these professionals include, but aren’t limited to:
- a medical doctor (MD)
- registered nurse (RN)
- nurse practitioner (NP)
- licensed practical nurse (LPN)
- physician assistant (PA)
- respiratory therapist (RT)
- physical therapist (PT)
- osteopathic physician (DO)
- or occupational therapist (OT)
Durable Medical Equipment (DME)
DME is equipment for medical purposes, can endure repeated use, and is fitting for home use. Some examples are wheelchairs, walkers, and oxygen tanks. You may buy or rent DME from a supplier approved by Medicare after your provider confirms you need it.
Home Health Services
Next, Part B covers services if you’re homebound and need therapy or skilled nursing care.
Medicare considers you “homebound” if:
- You need another person’s help or equipment like crutches, a walker, or a wheelchair to leave your home, or your physician believes your health (or illness) could worsen if you leave your home, and
- It’s hard for you to leave your home, and you usually can’t do so.
Your doctor should determine if you’re homebound based on his/her evaluation of your status. After you start getting home health care, your doctor will evaluate and recertify your care plan every 60 days.
These are medical screenings and counseling meant to prevent illness, identify conditions, and keep you healthy. In most cases, Medicare covers preventative care with no coinsurance.
Part B also covers emergency transportation, usually to and from hospitals.
There’s some coverage for non-emergency transportation. But, it’s restricted to situations where there’s no safe alternative available and where the transportation is “medically necessary.”
Related Post: Do Medicare Plans Cover Transportation?
Not to be overlooked, these are outpatient speech, physical, and occupational therapy services that a Medicare-certified therapist provides.
Note: This includes commonly covered items and services, but it’s not a comprehensive list. Remember that Medicare typically doesn’t pay the FULL cost of your care. And you’ll likely have to pay a percentage of cost-sharing — copayments, deductibles, coinsurance — for Medicare-covered services.
What Else Does Part B Cover?
- Mental health services
- Lab tests
- Chiropractic care — when manipulation is necessary to fix the spine (when one or multiple bones move out of position)
- Certain prescription drugs — including immunosuppressants, some anticancer drugs, some dialysis drugs, some anti-emetic drugs, and drugs that a physician typically administers.
Related Post: Medicare and Chiropractic Care: What’s Covered?
Please call (855) 952-1941 to speak with a licensed insurance agent for all your Medicare questions.