12.6.2 Medicare Part B - Medical Insurance
Medicare Part B is a voluntary program designed to provide supplemental medical insurance (SMI) to cover physician services, medical services and supplies not covered under Part A. Medicare Part B participants pay monthly premiums ($96.40 in 2009; unchanged from 2008) and are responsible for an annual deductible of $135 (2009; unchanged from 2008) for those filing individual income tax returns with incomes below $85,000 (2009; $82,000 in 2008). After the deductible, Part B will pay 80% of covered expenses.
Beginning in 2006, Part B's deductible was raised simultaneously and in conjunction with the premium rate. For instance, if the premium rate was raised by 5%, the deductible was also raised by 5%.
Premium amounts are adjusted according to income - the more you make, the higher premium payment you will be required to pay. Higher annual premiums are scheduled to be phased in over a five-year period.
Part B provides the following services.
- Outpatient hospital care
- Physicians' and surgeons' services
Covered medical and health services include, but are not limited to, the following.
- X-rays and tests
- Therapy
- Dressings
- Splints
- Casts
- Rental of medical equipment
- Prosthetic devices
Income-Related Premiums for Higher-Income Participants
Single participants with annual incomes over $85,000 (2009; $82,000 in 2008) and married couples with incomes over $170,000 (2009; $164,000 in 2008) will pay more for Medicare Part B coverage. Premiums will be based on income relating, or means testing, so that higher-income participants will pay a higher share of the total cost of coverage to relieve the financial burden on Medicare. The monthly premium charged to such higher-income beneficiaries will depend on their income and will equal 35, 50, 65, or 80 percent of the total cost.
The premium rate is determined on the basis of income and whether the beneficiary files an individual or joint income tax return. The rates differ for married participants who live with their spouses for any time during the taxable year but file separate returns.
(See ILL 20.2, page 310 of the Florida study manual.)
Primary Payor and Secondary Payor
If a Medicare participant is also covered under an employer-provided health care plan, the employer-sponsored plan would be considered the primary payor and Medicare the secondary payor.
(See page 310 of the Florida study manual for more detailed information.)
