Medicare First Principles: Medicare Part B Supplementary Medical Insurance Is Not Medigap

(NOTE: This is part of a continuing series of "Medicare First Principles" posts that began here and continued here and here. Future posts will look at Parts B, C, D and Medigap and how the costs shake out for all of the above, including out-of-pocket costs for the many health care services most of Medicare does not cover or cover in depth.)

Medicare Part B is typically considered the doctor's piece of the Medicare action but that thinking is much too simplistic. Medicare Part B is "supplementary medical" insurance¹ that does cover some very specific types of doctor visits and surgeries but that also covers a hospital's charges for certain outpatient procedures and even a hospital's charges when simply observing a patient that is not admitted (this distinction between observed and admitted has important financial implications covered under the description of Part A linked to above). 

Medicare Part B is also the part of Medicare that -- under conventional wisdom -- you pay for ($105 a month in 2013 for most beneficiaries). Of course, seniors pay for all of Medicare through direct and indirect payroll taxes deducted during his or her whole working life. That's the way seniors really need to look at Medicare. 

Under the Patient Protection and Affordable Care Act (PPACA) of 2010 -- better known as Obamacare -- the list of specifc types of doctor procedures covered was expanded. In fact a few of the procedures are now available with no co-pay, as opposed to the typical 20% co-pay required with Medicare services covered under Part B.

However, the most important preventive test -- an annual physical -- has never been covered by Original Medicare and is still not covered even after PPACA. This odd omission is simply one of the more confusing aspects of Medicare Part B. Among other types of doctor visits not covered, Medicare does not cover vision or hearing exams, routine dentisty, cosmetic surgery or acupuncture.

Part B also covers some so-called durable medical equipment and transportation by ambulance -- but not by wheelchair transit car -- in circumstance too numerous to describe in detail because of the complexity of what is covered and not covered and when.

¹ NOTE: Do not confuse the term "Part B supplementary medical insurance" with private "supplemental Medicare insurance," commonly called Medigap insurance.