Most Americans don’t realize all that is covered under Medicare Part B. The Medicare and You handbook says that Part B “helps to cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, and other medical services.” But, those are pretty broad terms to most.
To determine whether Medicare covers something, the key question you must always ask is, “is it medically necessary?”
The term “medically necessary,” as defined by Medicare, means “healthcare services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms that meets accepted standards of medicine.”
Medicare covers medically necessary doctor services (including outpatient services and some doctor services you get when you are a hospital inpatient) and covered preventative services. Medicare also covers services you get from other healthcare providers like physician assistants, nurse practitioners, social workers, physical therapists, and psychologists.
The simple answer is that in-office injections (like macular degeneration injections, which are expensive!) may be covered under Part B if they’re considered medically necessary for you.
What’s your out-of-pocket going to be? It will be the current year’s Part B deductible. The 2023 Part B deductible is $226. That is, once you pay $226, Medicare pays 80% of the Medicare-approved amount, while you pay 20% of that amount.
If you’re enrolled in a Medicare Supplement plan, it may help pay for your out-of-pocket cost.
Chapter 2 of the Medicare Survival Guide Advanced explains this in detail!
If Part B will not allow your specific injections to be considered medically necessary, check to see if your Part D plan will cover them.
What You Don’t Know Will Hurt You!
Turning 65 in America is a milestone and one of the markers is enrolling in Medicare. But the system is so complicated, and there is a lot of false information out there.
In Toni King’s Medicare Survival Guide Advanced: Basics and Beyond, Toni gives you the critical steps you need to enroll in Medicare properly. Toni shares various situations that she has experienced with her many clients during Medicare consultations, and gives you the information and tools you need to enroll on time to avoid the “famous” Medicare Part B and D penalties.
Medicare Survival Guide Advanced helps you understand Medicare step by step…
Learn How to Enroll the Correct Way
• Still Working Past 65
• Turning 65
• VA Benefits
• Laid-off or Retiring
What Medicare Option Is Best for You
• Medicare Supplement vs. Advantage
• Losing Retirement Benefits
How to Avoid
• The Donut Hole
• Part B Penalties
• Part D IRMAA Penalties
If you are enrolling in Medicare and are confused by the commercials and telemarketers, or from the information that well-meaning friends or family members give, let Toni guide you through the maze of Medicare. Order TODAY!
Originally published January 19, 2023