The Centers for Medicare and Medicaid Services (CMS), a component of the Department of Health and Human Services (HHS), administers Medicare and Medicaid programs. Medicare Supplementary Medical Insurance (also called Medicare Part B) is available to the elderly, individuals with disabilities, and those with end stage renal (kidney) disease. The Social Security Administration is responsible for determining Medicare eligibility and processing premium payments for the Medicare program.
Medicare Part B was created to help cover additional medical-related expenses that are not covered under Medicare Part A (the hospital benefit). After a deductible is met, Medicare Part B pays 80% of what the government considers to be the "reasonable charge" for covered services. The covered individual must then pay the remaining 20% of the charges. The "reasonable charge" will usually be less than the actual amount charged. Some providers will accept Medicare's "reasonable charge" and not charge the patient the additional 20% for some services. If not, the patient is responsible for this amount.
Currently, individuals who receive Social Security retirement benefits or who receive Social Security disability benefits for 24 months, or those entitled to Medicare Part A, are automatically enrolled in Part B. They do have the option to decline coverage. Others can enroll in Part B by completing a request form at the Social Security office during certain enrollment periods.
Medicare Part B is the benefit that pays for physicians' services. It also covers home health care, durable medical equipment, outpatient physical therapy, x-rays, diagnostic tests, some drugs and supplies. A complete list of items and services which may be covered under Part B can be found at The Center for Medicare Advocacy. This benefit is generally for services and medical assistance devices utilized on an outpatient basis.
Medicare Part B does exclude certain services and medical items and is governed by "medical necessity" rules. Excluded items include prescription drugs that don't require administration by a physician as well as some eyeglasses, hearing aids, dental services, and routine foot care.
For more information on Medicare Part B, go to:
Part B Premiums, Deductible, and Copays
Diabetes Self-management Training http://www.medicareadvocacy.org/FAQ_PartB.cfm#DIABETES%20
Durable Medical Equipment (DME) http://www.medicareadvocacy.org/FAQ_PartB.cfm#DURABLE%20MEDICAL
Home Oxygen Therapy
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