Medicare Part B
Original Medicare is comprised of Medicare Part A and Medicare Part B. Medicare Part B is known as the "medical insurance" and covers most outpatient healthcare services.
What Does Medicare Part B Cover?
Medicare Part B (also known as medical insurance) covers the services stated below:
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Services from your doctor and other healthcare providers
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Outpatient doctor visits
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Clinical research, including drugs trials
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Emergency services
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Ambulance services for transport to a hospital or skilled nursing facility
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Medical supplies such as blood sugar test strips and testing monitors for patients with diabetes, etc.
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Durable medical equipment (DME) such as beds, wheelchairs, walking frames, oxygen supplies, and nebulizers
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Some prescription drugs like immunosuppressant drugs, anti-cancer drugs, anti-emetic drugs, dialysis drugs, and certain drugs that a physician administers.
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Medical services which include lab tests, X-rays, and screening tests for cancer, diabetes, bone density, and glaucoma.
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Preventative care services, including counseling
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Mental health services, including visits to a psychiatrist or specialist nurse practitioner
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Other outpatient treatments such as chiropractic services and acupuncture for lower back pain.
What Services Are NOT Covered Under Medicare Part B?
Medicare Part B does not cover some items or services. These include:
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Hearing exams, including hearing aids
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Routine foot care except for foot ulcers and conditions caused by cancer, diabetes, or chronic kidney disease.
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Routine eye exams, including contacts.
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Home safety items
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Healthcare outside the United States
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Routing Dental Services like cleanings or fillings
What Are Medicare Part B Costs?
Premium
Most people pay the standard Part B premium amount of $164.90. This amount will be automatically deducted from your benefits if you receive benefits from either of the following:
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Social Security
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Railroad Retirement Board
However, you may pay the monthly premium and an extra charge if your modified adjusted gross income is above a certain amount. This extra charge is called Income Related Monthly Adjustment Amount (IRMAA).
You may also pay a late penalty if you didn't enroll when you first became eligible (when you turned 65). This may be up to 10% of the standard premium for each 12-month period you delay your enrollment. You'll have to pay this penalty for as long as you are enrolled in Part B.
Note: If you have employer coverage, you can delay enrolling into Medicare Part B until you (or your spouse) stop working or lose that employer coverage. You won't have to pay a late enrollment penalty fee if you enroll within the eight months (Special Enrollment Period) of losing your coverage.
Also, if you have retired and want to return to work that offers employer coverage, you can always pause your Medicare Part B coverage and re-enroll once your employer coverage ends without paying the late enrollment penalty.
Deductible and Coinsurance
All enrollees pay the standard annual deductible for Medicare Part B before they begin to enjoy Medicare benefits. The amount could vary by year. In 2023 the Part B deductible is $226 per year. After meeting your deductible, Medicare will pay 80% while you pay a 20% coinsurance of the Medicare-approved price of covered services, including doctor fees, while you're admitted to a hospital, outpatient therapy, and durable medical equipment (DME).
Am I Eligible For Medicare Part B?
You become eligible to enroll in Medicare Part B three months before you turn 65. This is called your Initial Enrollment Period which spans over seven months. This period start three months before you turn 65, the month you turn 65, and three months after your birth month.
However, you must be aged 65 and meet the following requirements before you qualify fully for Medicare Part B:
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You must be a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years
If you are under-65, you are eligible for Medicare Part B if you:
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Have end-stage renal disease (ESRD)
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Have amyotrophic lateral sclerosis (ALS)
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Have qualified for Social Security retirement benefits and have received Social Security Disability Insurance (SSDI) for at least 24 months (not necessarily consecutive)
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Have qualified for certain disability benefits from the Railroad Retirement Board for 24 months
How Do I Get Enrolled In Medicare Part B?
According to the federal government policy, you get automatically enrolled into Medicare Part B if you meet one of the following criteria:
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You will receive retirement benefits from either Social Security or the Railroad Retirement Board when you turn 65 years old. Usually, your Medicare card will be mailed to you about three months before your 65th birthday.
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You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS).
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You have End-Stage Renal Disease where you require regular dialysis or a kidney transplant.
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You have received Social Security Disability Insurance (SSDI) for at least 24 months. So, you are automatically enrolled in your 25th month.
Aside from the above, you can manually enroll in Medicare Part B if eligible. You can enroll penalty-free during one of the following periods:
Initial Enrollment Period (IEP)
The initial enrollment period is a 7-month window where you are allowed to enroll in Medicare when you turn 65. This 7-month period includes the three months before the month you turn 65, your birth month, and three months after the month you turn 65. If you are delaying your Social Security Benefits beyond age 65 and do not have Employer Group Coverage, you will need to apply for Medicare in order to be enrolled.
General Enrollment Period (GEP)
This period runs from January 1st to March 31 each year. Medicare coverage starts on the 1st of July each year when you enroll during this period.
Special Enrollment Period (SEP)
This enrollment period only happens when there is a qualifying situation or event for it. The most common situation we see is someone who is 65 and 3 months or older who is still working and covered under a group health plan based on the current employment of either themselves or their spouse. This person can apply for Medicare part B using a SEP (Special Enrollment Period) in either of the following situations:
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During any month you are covered under you or your spouses group plan and the current employment continues.
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In the 8 month period that begins the first month your employer group health coverage ends.
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