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AHIP Medicare - Module 1 - Overview of Medicare Program Basics: Choices, Eligibility, and Benefits - PART B

Healthcare7 CardsCreated 9 months ago

This deck generally covers outpatient services including doctor visits, lab tests, durable medical equipment, home health care, physical therapy, and chemotherapy. It also includes ambulance services, diabetic supplies, dialysis, telehealth (with limits), and more.

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Original Medicare, Part B, generally covers 8 services:

  1. Physician and other health care professional services

  2. Outpatient hospital services

  3. Clinical lab and diagnostic tests, such as X-rays, MRIs, CT scans

  4. Durable medical equipment

  5. Home health care that is not covered under Part A (because the individual was not in a hospital for SNF or has exceeded 100 days)

  6. Physical and occupational therapy

  7. Ambulatory surgical center services

  8. Chemotherapy provided on an outpatient basis

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Key Terms

Term
Definition

Original Medicare, Part B, generally covers 8 services:

  1. Physician and other health care professional services

  2. Outpatient hospital services

  3. Clinical lab and diagnosti...

Medicare Part B - 9 Other Items and Services:

  1. Ambulance services

  2. Chiropractic servicers - for limited situations

    ...

Medicare Part B - Original Medicare Cost Sharing
($226 annual deductible)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

Medicare Part B - Original Medicare Cost Sharing
(After the $226 annual deductible is satisfied/paid)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

Medicare Part B - Original Medicare Cost Sharing
(After the $226 annual deductible is satisfied/paid)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

Medicare Part B Benefits - Preventive Services and Screenings:

Beneficiaries covered under Original Medicare Advantage plans will have no cost-sharing for most preventive services.

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AHIP Medicare - Module 1 - Overview of Medicare Program Basics: Choices, Eligibility, and Benefits - PART B
TermDefinition

Original Medicare, Part B, generally covers 8 services:

  1. Physician and other health care professional services

  2. Outpatient hospital services

  3. Clinical lab and diagnostic tests, such as X-rays, MRIs, CT scans

  4. Durable medical equipment

  5. Home health care that is not covered under Part A (because the individual was not in a hospital for SNF or has exceeded 100 days)

  6. Physical and occupational therapy

  7. Ambulatory surgical center services

  8. Chemotherapy provided on an outpatient basis

Medicare Part B - 9 Other Items and Services:

  1. Ambulance services

  2. Chiropractic servicers - for limited situations

  3. Opioid use disorder treatment

  4. E-visits

  5. Diabetic supplies

  6. Kidney dialysis

  7. Outpatient mental health care (limits apply)

  8. Certain telehealth services (During the COVID-19 public health emergency and for five months after telehealth services are covered in any location in the U.S. including the home).

  9. Continuous Positive Airway Pressure

Medicare Part B - Original Medicare Cost Sharing
($226 annual deductible)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

  • A @226 annual deductible. The deductible does not apply to certain Part B-covered preventive services.

Medicare Part B - Original Medicare Cost Sharing
(After the $226 annual deductible is satisfied/paid)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

After the deductible is satisfied/paid, beneficiaries typically pay 20% of the Medicare-approved cost for Part B covered services.

Medicare Part B - Original Medicare Cost Sharing
(After the $226 annual deductible is satisfied/paid)

In 2023, beneficiaries pay the following amounts for Part B services covered under Original Medicare:

After the deductible is satisfied/paid, beneficiaries typically pay 20% of the Medicare-approved cost for Part B covered services.

Medicare Part B Benefits - Preventive Services and Screenings:

Beneficiaries covered under Original Medicare Advantage plans will have no cost-sharing for most preventive services.

What are the 9 services that are NOT covered by Original Medicare:

  1. Health care while traveling outside the U.S.

  2. Cosmetic surgery

  3. Custodial/long-term care

  4. Outpatient prescription drugs (this is covered under Part D)

  5. Most dental care (however, Original Medicare may pay for some dental services before, or as part of, certain related medical procedures (like before certain cardiac or organ transplant procedures.

  6. Massage Therapy

  7. Eye exams for glasses

  8. Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

  9. Covered items or services provided by a doctor or other provider who has opted out of Medicare (except in the case of an emergency or urgent need)