Medicare Part B Doctor’s Benefits in Florida

Medicare Part B, one of the two major parts of Original Medicare, offers medical insurance to Florida residents eligible for Medicare. Part B provides coverage for medically-necessary services including certain doctor’s services, outpatient care, durable medical equipment, home health services, and preventative services.

How are Florida residents eligible for Medicare Part B?

U.S. citizens and permanent residents of five years or more, including those in the state of Florida, are eligible for Medicare Part B enrollment once they reach the age of 65. However, Florida residents may qualify for Part B enrollment under the age of 65 if they have a qualifying disability or illness.

Medicare Part B enrollment is automatic for most Florida Medicare beneficiaries. They should expect to receive a Medicare card in the mail three months before their month of eligibility. For Florida residents who are eligible for Part B but have not received a Medicare card in the mail, they may have to fill out an application for Medicare Part B enrollment.

What does Medicare Part B cover?

Medicare Part B offers a variety of medical services for eligible Florida Medicarebeneficiaries. Part B coverage includes, but is not limited to, the following:

  • Ambulance services
  • Durable medical equipment, including wheelchairs, walkers, and hospital beds, and oxygen supplies and equipment
  • Prosthetic/Orthotic items, including braces and artificial eyes or limbs
  • Flu shots once per flu season during the fall or winter
  • Certain preventative screenings, such as mammograms and screenings for colorectal cancer, prostate cancer, and diabetes
  • A “Welcome to Medicare” physical exam and a yearly “wellness” exam each year after that
  • Certain therapy and counseling services, including occupational therapy, smoking cessation counseling, and speech-language pathology services
  • Tests, other than lab tests, such as X-rays, MRIs, EKGs, and other diagnostic tests

How much does Medicare Part B cost?

The Medicare Part B monthly premium changes annually. In 2012, most Florida Medicare beneficiaries will continue to pay $115.40 while individuals enrolling for the first time will pay $99.90. Higher-income Florida residents ($85,000 for individuals and $170,000 for couples) can expect to pay a higher Part B premium.

There is also a yearly Part B deductible that must be paid before Medicare begins to pay its share. In 2012, the Part B deductible is $140 a year. After the Part B deductible is met, Florida Medicare beneficiaries are responsible for paying 20% of the Medicare-approved amount for the service (also known as “reasonable charge”), while Medicare pays the remaining 80%.

Please note that if a doctor does not accept the “reasonable charge” as full payment (also known as “accepting assignment”), you would be responsible for paying the additional 15% that the doctor is allowed to bill. This means that your total share of the cost would then be 35%.

Should Florida residents sign up for Medicare Part B?

Florida residents who are eligible for Part B and do not have credible health coverage from an employer or union, should sign up for Medicare Part B as soon as they are eligible to avoid incurring a late enrollment penalty. For each 12-month period Part B enrollment is delayed, a 10% premium penalty (based on the standard Part B premium) would be added onto the monthly Part B premium amount.

After signing up for Original Medicare, beneficiaries should consider enrolling in a Medicare Advantage, Medicare Part D, or Medicare Supplement plan for additional coverage. Original Medicare only covers certain medical and hospitalization benefits and does not cover all health care costs, including medication costs.