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Medicare Part B

Medicare Part B is a part of the Original Medicare and offers benefits for medical services. 

Part B usually covers 2 types of services:

  • Medically necessary services: these are the services (or supplies) that are needed to diagnose or treat your specific medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness such as the flu, or detect it at an early stage, when treatment is most likely to work best.

You will most likely have to pay nothing for most preventive services if you get the services from a healthcare provider who accepts assignment which is an agreement by your doctor, provider, or supplier to be paid directly by Medicare.

 

 

What are

Medicare
Part B Benefits

Cartoon artwork explaining Medicare Part B

Part B covers things like:

  • Ambulance services
  • Durable medical equipment
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Limited outpatient prescription drugs
  • Clinical research

Part B offers coverage for many outpatient medical services. It offers benefits for preventive services like cancer screenings, vaccines, lab work, and many more preventive services. It will also help pay for mental health services and durable medical equipment.

While Part A is your “room and board” for hospital stays, Part B will also pay for services performed while under inpatient hospital care. It will cover diagnostic images, surgeries, dialysis, chemotherapy, and medications delivered by injection. 

Coverage Not Included in Medicare Part B

Medicare Part B does not offer coverage for routine dental, vision, or hearing benefits. It will also not provide coverage for services or treatments that are not considered medically necessary (this includes most cosmetic surgeries, plus all alternative forms of medical care such as acupuncture, acupressure, and homeopathy). Part B also does not cover outpatient prescription drugs as a rule and doesn’t cover most vaccinations and immunizations.

To conclude, Part B Medicare insurance is intended to pay for only a portion of medical bills, outpatient hospital and clinic charges, laboratory work, some home health care, physical and speech therapy, and very few drugs as well as medical supplies.

How much does Medicare Part B cost?

There are several things to consider when calculating the cost of Medicare Part B. Individuals will have a monthly premium, annual deductible, and coinsurance. Part B covers 80% of covered services after the annual deductible has been met.

Currently, the monthly premium for Medicare Part B is $164.90. This is the standard premium that many people pay. However, if an individual’s adjusted gross income is higher than a certain amount, the premium will be increased. If the individual is receiving Social Security benefits, Railroad Retirement benefits, or Office of Personnel Management benefits, the Part B premium will be automatically deducted from those monthly checks. Otherwise, Medicare may send a monthly bill that can be paid online with the Easy Pay method.

The Part B annual deductible is currently $226. Both the premium and deductible can be increased each year.

What copays does Medicare Part B have?

Part B does not have any copays.

Who is eligible for premium-free Part B?

The qualifications for Medicare Part B are similar to those for Part A and if you qualify for Medicare Part A without a premium, you’re also eligible for Part B.While most individuals pay a monthly premium for Part B, some lower-income beneficiaries and those who are eligible for both Medicare and Medicaid can qualify for premium-free Part B through the Medicare Savings Program.

The standard eligibility requirements for Part B are:

  •  You’re a U.S. citizen or a permanent legal resident who has lived in the U.S. for more than five years and,
  • You are 65 or older
  • You have been on Social Security Disability Insurance (SSDI) for two years
  • You have end-stage renal disease (ESRD)

How to Apply for Medicare Part B

Individuals who have been receiving Social Security benefits prior to age 65 will automatically be enrolled in Medicare Parts A and B. A Medicare ID card will be sent to the individual’s mailing address the month before their 65th birthday. If an individual is not currently receiving Medicare benefits, they must apply for benefits themselves by either submitting an application online or calling the Social Security Administration office.

The Inital Enrollment Period for Medicare Parts A and B begins three months before an individual’s 65th birthday and continues until three months after their birthday. Unless the individual has other creditable health coverage, not enrolling during the Initial Enrollment Period will cause the beneficiary to incur a penalty.

The penalty will not be applied if the individual qualifies for a Special Enrollment Period. This enrollment period applies to those who did not enroll at age 65 but had other creditable health insurance. Look into other enrollment periods to get more insight into your enrollment options.

Reinstating Medicare Part B

If your Medicare Part B benefits get interrupted due to a lack of payment, individuals must get them reinstated by submitting a new application.

Get help with

Medicare Part B

Original Medicare – Parts A and B – does not cover 100% of medical expenses. There are additional options that beneficiaries can obtain to help pay for healthcare. Our knowledgeable agents can discuss your options and help you decide on additional coverage that meets your needs.

Talk with an Advisor

Questions to be advised on:

The Missouri Medicare Advisor website character Alex Dickneite discussing Questions to be advised on.

Part B does cover several medications administered by injection, but most prescription drugs are covered under a separate Part D plan.

If you are not automatically enrolled in Medicare and missed your Initial Enrollment Period, it could take 30-60 days for your application to be approved.

Your doctor will bill Medicare for the services rendered. Medicare will then send you the bill for the deductible.

Yes! You can enroll for Medicare Part B online at www.socialsecurity.gov.

Even though Medicare Advantage plans offer “all-in-one” coverage, you must still pay the Part B premium. There are some Medicare Advantage plans that have a Part B premium reduction benefit.

If you have other creditable health insurance, you do not have to enroll in Medicare Part B and can delay coverage without a penalty. Make sure your current coverage has been deemed “creditable.”

Individuals can only avoid the Part B premium if they qualify for a Medicare Savings Program.

Medicare Part B does not offer coverage for eyeglasses.

Most people pay the same standard premium for Part B. However, individuals in a higher income bracket will pay a higher monthly premium and those in a lower income bracket may pay a lower monthly premium.

If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you must wait for the General Enrollment Period that occurs each year from January 1 through March 31.

No, eligibility for Part B is only based on age and disability.

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