Taking Care of Mom and Dad: Medicare Part B

Medicare Part B is medical expense insurance covering costs associated with doctors' services, outpatient care, laboratory tests, x-rays, mammograms and pap smears and medical supplies. Your parents will have to pay the first $100, which is the annual deductible, then Medicare will pay 80 percent of all approved charges for any eligible medical expense. The approved charge may or may not be close to the actual fee charged by your parents' provider. This means they are responsible for the difference...as well as the additional 20 percent of the approved charge.

Fortunately, when doctors accept a Medicare assignment, they agree to charge no more than Medicare's approved charge.

Here's what Part B covers:

• doctors' services provided on an inpatient or outpatient basis, no matter where received in the United States, including surgical services, diagnostic tests and x-rays, medical supplies furnished in a doctor's office and services of the office nurse;
• services of clinical psychologists, chiropractors, podiatrists and optometrists;
• outpatient diagnostic services and lab fees, such as care in an emergency room or outpatient clinic of a hospital;
• outpatient physical and speech therapy;
• dental work that is required due to accident or disease;
• the use of outpatient medical equipment such as iron lungs, braces, colostomy bags and prosthetic devices such as artificial heart valves;
• ambulance service, if the patient's condition requires it;
• outpatient psychiatric care (there is a 50 percent copayment instead of 20 percent);
• the cost of certain vaccines and antigens (only medicines that are administered at the hospital or at a doctor's office are covered by Medicare. Drugs that can be self-administered -- taken at home -- are not covered, even if prescribed by a doctor);
• an unlimited number of home health care visits, if all required conditions are met and your parents do not have Medicare hospital (Part A) coverage;
• preventive health care expenses such as pap smears and mammography (however, mammograms are covered only when performed in a Medicare-approved facility); and
• one pair of eyeglasses following cataract surgery.

Blood is a covered expense under Part B (also Part A). In essence, there is a "three-pint deductible" for blood, which means that Medicare is responsible for either paying for the first three pints of blood or replacing the blood. The blood deductible for Part B can be used to satisfy the blood deductible for Part A. Thus, only one threepint deductible is required. However, any blood provided under Part B is still subject to the 20 percent copayment.

Under Part B, there are a number of services that do not require a deductible or a copayment, including:

• the cost of a second opinion required by Medicare for surgery;
• home health services (except the 20 percent copayment applies to the use of certain medical equipment);
• pneumococcal vaccine (flu shots);
• outpatient clinical diagnostic lab tests conducted by Medicare-certified facilities or doctors who accept assignments.

There is a fee for Part B (Medical Expenses). In 2002, the monthly premium was $54 and automatically deducted from Social Security payments. Enrollment is automatic -- unless your parents state that they don't want it -- when they are eligible for premium-free Part A.

If your parents don't qualify for premium-free Part A, but are 65 or older, they can still buy Part B.