Part B pays for medical services such as doctor’s visits and other health care providers, outpatient services, diagnostics (laboratory services, x-rays, ect) some home health care, durable medical equipment and some preventive services. Part B has a monthly premium and is based on taxable income. You are eligible for this coverage when you turn 65. Part B has an annual deductible that can change yearly. After the deductible Part B pays 80% of covered services and you pay the remaining 20% of cost. Original Medicare does not have an Out-of-Pocket maximum to protect against catastrophic expenses.
Medicare Advantage Plans (called Part C)
Part C Medicare Advantage Plans works like traditional major medical insurance and is offered through private insurance companies approved by Medicare to provide this coverage. These plans can be an HMO, PPO, or PFFS (Private Fee for Service) which determines what providers you can see for services. There are networks that provide services and out-of-pocket expenses such as premium payments, copays, deductibles, coinsurance and out-of-pocket maximums. You must be enrolled in Part A and B to be eligible for a Medicare Advantage plan. You’ll get your Medicare Part A (hospital) and Part B (Medical) coverage from the Medicare Advantage Plan, not Original Medicare. Some plans can cover extras such as dental, vision, hearing aids, pharmacy and wellness/fitness.
Medicare Advantage Plans must follow the rules set by Medicare. However, each Medicare Advantage plan can charge different out-of-pocket costs and have different guidelines for how you get services, like whether you need a referral for a specialists. The plan provisions can change each year but the plan must notify you about any changes before the start of the next enrollment year. Each year Medicare Advantage Plans can choose to leave Medicare, if this occurs you will need to choose another plan or return to Original Medicare. If you have this type of plan you can’t be sold a Medicare Supplement Insurance (Medigap). You can only enroll in a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.