PART B: MEDICAL INSURANCE
Part B medical insurance helps pay for
some services and products not covered by
Part A, generally on an outpatient basis (but
also when on an unadmitted observation
status in a hospital). Part B is optional and
may be deferred if the beneficiary or his/
her spouse is still working and has group
health coverage through that employer.
There is a lifetime penalty (10% per year on
the premium) imposed for not enrolling in
Part B unless actively working and receiving
group health coverage from that employer,
or covered by programs of the Veterans
Health Administration.
Part B coverage begins once a patient
meets his or her deductible ($183 for 2017),
then typically Medicare covers 80% of the
RUC-set rate for approved services, while
the remaining 20% is paid by the patient,
either directly or indirectly by private group
retiree or Medigap insurance.
Part B also helps with durable medical
equipment (DME), including canes, walkers,
lift chairs, wheelchairs, and mobility
scooters for those with mobility impair-
ments. Prosthetic devices such as artifi-
cial limbs and breast prosthesis following
mastectomy, as well as one pair of eyeglasses
following cataract surgery, and oxygen for
home use is also covered.
PART C: MEDICARE ADVANTAGE
PL ANS
Public Part C Medicare Advantage
health plan members typically usually also
pay a monthly premium in addition to the
28 HimPower March 2018
Medicare Part B premium to cover items
not covered by traditional Medicare (Parts
A & B), such as the OOP limit, prescription
drugs, dental care, vision care, annual phys-
icals, coverage outside the United States,
and even gym or health club memberships
as well as—and probably most importantly—
reduce the 20% co-pays and high deduct-
ibles associated with Original Medicare.
PART D: PRESCRIPTION DRUG PL ANS
Medicare Part D went into effect on
January 1, 2006. Anyone with Part A or B
is eligible for Part D, which covers mostly
self-administered drugs. It was made
possible by the passage of the Medicare
Modernization Act of 2003. To receive
this benefit, a person with Medicare must
enroll in a stand-alone Prescription Drug
Plan (PDP) or Medicare Advantage plan
with integrated prescription drug coverage
(MA-PD). These plans are approved and
regulated by the Medicare program, but
are actually designed and administered
by private health insurance companies
and pharmacy benefit managers. Unlike
Original Medicare (Part A and B), Part D
coverage is not standardized (though it is
highly regulated by the Centers for Medi-
care and Medicaid Services). Plans choose
which drugs they wish to cover (but must
cover at least two drugs in 148 different
categories and cover all or "substantially all"
drugs in the following protected classes of
drugs: anti-cancer; anti-psychotic; anti-con-
vulsant, anti-depressants, immuno-suppres-
sant, and HIV and AIDS drugs). The plans