What is Medicare Part B? What does Medicare Part B cover?

Many individuals perceive it as medical coverage; however, it extends its scope to both within and outside the hospital setting. Consider Part B coverage as encompassing care provided by medical professionals.

What Does Medicare Part B Cover?

Medicare Part B coverage grants you access to an array of outpatient medical services. It includes preventive care like flu shots, colonoscopies, mammograms, and more. It caters to routine outpatient services such as doctor’s appointments, lab tests, home health care, ambulance transportation, and even some chiropractic care.

Nonetheless, Medicare Part B also covers services that might occasionally occur within a hospital environment. This encompasses services like physician care, cancer treatments like radiation or chemotherapy, surgical interventions, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B also extends coverage to drugs administered within a clinical setting, such as osteoporosis injections, infused medications, antigens, and insulin utilized with an insulin pump.

Outpatient medications, however, fall under Part D.

Part B is optional, yet if Medicare is your primary coverage, having Part B is crucial. Medigap supplemental coverage is also contingent on its inclusion.

What does Medicare cover in terms of costs under Part B?

Covers 80% of approved costs after your initial payment of the annual deductible.

How Much Will I Pay for Medicare Part B?

Monthly premium payments are necessary for your Medicare Part B benefits. The majority of Americans adhere to the standard monthly amount established by the government. In 2023, the base rate for Part B is $164.90/month for newcomers to Medicare. However, there might be a higher amount owed for individuals whose income surpasses a specific level.

A chart displaying costs based on your income bracket can be found on our Medicare cost page. Enrolling late into Part B could potentially lead to a lifelong penalty. It’s imperative not to miss your enrollment window during retirement, as losing access to employer group health insurance might occur.

If you are already enrolled in your SS income benefits, Medicare will deduct your Part B premiums from your Social Security check. For those not enrolled, quarterly billing will take place, with a credit card payment option available. To pay for Part B using a credit card, simply complete the payment coupon’s bottom portion and send it to the Medicare Premium Collection Center.

Another option is Medicare Easy Pay, a free auto-draft service facilitating monthly deduction of premium payments from a checking or savings account.

How Do I Sign Up for Medicare Part B?

Individuals receiving Social Security income benefits at age 65 are automatically enrolled, with the Social Security office handling this process. Your card arrives in the mail 1 – 2 months before your 65th birthday.

For everyone else, application for Medicare Part B is necessary at age 65. Applying can be completed online, over the phone, or in-person at your local Social Security office. After application, it takes 2 – 3 weeks for your card to arrive, so applying several weeks before coverage is needed is advisable.

As evident, signing up for Part B is straightforward. Enrolling during your Initial Enrollment Period is vital, unless other credible coverage is in place. Failing to do so might result in a penalty.

For additional details on each application option, visit our Apply for Medicare page.

A suitable perspective is to regard Part B as coverage for any care provided by physicians and considered medically necessary.

Does Medicare Part B Cover Everything Outpatient?

Part B typically covers anything deemed medically necessary. If a doctor documents the need for a specific procedure, it’s generally covered. Disagreements between Medicare and the physician regarding medical necessity might require additional documentation.

What Doesn’t Part B Cover?

Part B excludes hospital expenses covered by Part A. It also omits cosmetic procedures, routine dental, vision or hearing care, and routine foot care. Additionally, drugs obtained from a retail pharmacy are not covered; a Part D drug plan is required.

In general, Part B doesn’t cover services considered unreasonable or unnecessary. Physicians typically understand the rules governing covered and non-covered services.

What is My Cost Sharing Under Medicare Part B?

You’re responsible for a portion of the costs for your medically necessary Part B services, which generally include:

The annual Part B deductible ($226 in 2023)

20% of the remaining costs, without limitations or caps

Any additional charges from providers or facilities beyond what Medicare reimburses

Significant among these is the 20% you owe for outpatient medical care. Expenses for services like surgeries or chemotherapy can accumulate to thousands. Fortunately, a range of supplemental coverage options exists to suit various budgets.

What is the Medicare Part B Late Enrollment Penalty?

Failure to enroll in Medicare when initially eligible, coupled with the absence of creditable coverage, leads to the Medicare Part B late enrollment penalty. This penalty amounts to 10% per year for each year (12 full months) of delayed enrollment. The penalty is applied to the standard Part B premium, set at $164.90 in 2023.

Upon eventual enrollment, you must await the Medicare General Enrollment Period to sign up for Part B. This period runs from January 1st to March 31st each year. Benefits commence the following month after application. This situation entails a double setback: not only incurring a penalty but also waiting months for coverage initiation.

If delayed enrollment results from having employer group health coverage from a company with 20 or more employees, you’re exempt from the Part B late enrollment penalty. Upon leaving such coverage, an 8-month window to sign up for Part B is granted – this is your Special Enrollment Period for Medicare.

Opting to enroll in Medicare during your Initial Enrollment Period remains the most effective strategy to avoid the Medicare Part B late enrollment penalty. Additional information on Medicare enrollment periods can be found here.

Seek Assistance with Medicare Part B

Two primary approaches safeguard against significant medical expenses:

  1. Medicare supplements can be purchased to cover areas not addressed by A & B.
  2. Medicare Advantage plans provide an alternative if you’re open to obtaining A & B benefits through a private health insurance plan featuring a smaller network than Medicare.

Learn more about purchasing a Medicare Supplement or enrolling in a Medicare Advantage plan. Contact us for a complimentary consultation at (855) 732-9055 today. Our experts can help you compare options, elucidate your Medicare Part B coverage, and identify the most fitting plan for you.