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Questions and Answers
What does Medicare Part B pay for?
What does Medicare Part B pay for?
What percentage of approved charges does Part B generally pay for covered expenses after the deductible?
What percentage of approved charges does Part B generally pay for covered expenses after the deductible?
80%
Part B of Medicare is mandatory for everyone who enrolls in Part A.
Part B of Medicare is mandatory for everyone who enrolls in Part A.
False
When can you re-enroll in Part B if you initially declined it?
When can you re-enroll in Part B if you initially declined it?
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What types of doctor services are covered by Part B?
What types of doctor services are covered by Part B?
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What are the limitations on home health visits covered by Medicare?
What are the limitations on home health visits covered by Medicare?
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Which of the following is NOT covered by Medicare Part B?
Which of the following is NOT covered by Medicare Part B?
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Under what circumstances are prescription drugs covered by Part B?
Under what circumstances are prescription drugs covered by Part B?
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Medicare covers outpatient treatment of mental illness at the usual 20% coinsurance.
Medicare covers outpatient treatment of mental illness at the usual 20% coinsurance.
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What does the yearly 'wellness' visit allow for?
What does the yearly 'wellness' visit allow for?
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Study Notes
Medicare Part B Overview
- Part B covers doctor services, outpatient hospital services, home health visits, and certain medical supplies not included in hospital insurance.
- Optional enrollment during Part A application; funded through monthly premiums and federal government revenues.
- After enrolling, individuals can only re-enroll during the general enrollment period (Jan 1 - Mar 31) if they previously declined Part B.
- After meeting the annual deductible, Medicare pays 80% of approved charges for covered expenses; no maximum out-of-pocket limit on the 20% coinsurance.
Coverage Details
- Doctor Services: Covers surgical services, diagnostic tests, X-rays, medical supplies in a doctor's office, and office nurse services across the U.S.
- Outpatient Hospital Services: Includes treatments and diagnosis received in emergency rooms, outpatient clinics, and hospitals.
- Home Health Visits: Medicare funds part-time home health services as recommended by a doctor, with service limits. Non-fully covered services may fall under Medicaid.
Additional Services Covered
- Other Medical Services: Covers ambulance transportation, home dialysis supplies, lab tests, outpatient physical therapy, speech pathology, and certain radiation treatments under specific conditions.
- Prescription Drugs (Limited Coverage): Covers certain medications administered in outpatient settings or those related to durable medical equipment. Most prescription drugs require full payment unless covered by Part D.
- Outpatient Mental Health Treatment: Covers outpatient mental health services with a 45% coinsurance instead of the standard 20%.
Preventive and Wellness Care
- Yearly "Wellness" Visit: An annual visit allows patients to develop or update a personalized disease prevention plan after an initial "welcome" visit available in the first 12 months.
Exclusions from Part B
- Does not cover private duty nursing, extended skilled nursing home care beyond 100 days, excess physician charges, most outpatient prescription drugs, foreign care, custodial home care, certain dental care, cosmetic procedures, eyeglasses, hearing aids, orthopedic shoes, acupuncture, and expenses related to war.
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Description
This quiz provides an overview of Medicare Part B, detailing the services it covers, including doctor visits and outpatient care. It highlights enrollment periods, deductible information, and coverage specifics for medical supplies. Test your understanding of how Medicare Part B functions and its importance in healthcare.
