Preparing to select a Medicare plan? Regardless of your choice between Original Medicare and various Medicare Advantage plans, all of them provide coverage for Medicare Part B.
What is Medicare Part B?
Medicare Part B generally includes care and services administered at outpatient facilities or clinics. It is part of Original Medicare, along with Part A, which typically covers care at hospitals and certain skilled nursing facilities.
What Medicare Part B covers?
Medicare Part B covers two types of services: medically necessary outpatient care and preventive services.
Medically necessary outpatient care: Medicare Part B encompasses a range of outpatient care and services when they are deemed medically necessary. According to the Centers for Medicare & Medicaid Services, medically necessary services are defined as “services or supplies needed for diagnosing or treating your medical condition, meeting accepted standards of medical practice.”
Once you have met your annual Medicare Part B deductible, Part B generally pays 80% of the cost for covered medically necessary services. You are responsible for a 20% Part B coinsurance for most covered services.
Here are some examples of medically necessary services covered by Medicare Part B:
- Ambulance services, including ground transportation to a hospital
- Durable medical equipment such as wheelchairs, walkers, and hospital beds
- Heart disease screenings
- Cardiac rehabilitation, including exercise, education, and counseling
- Cancer screenings, including cervical, vaginal, lung, breast, prostate, and colorectal cancer
- Chemotherapy for cancer treatment
- Diabetes care, including equipment and supplies like test strips and lancets
- Certain acupuncture and chiropractic services
- Physical therapy
- Screenings for depression, diabetes, hepatitis C, and HIV
- Diagnostic tests such as X-rays, MRIs, CT scans, and EKGs/ECGs
- Flu shots and other vaccines
- Diabetes-related foot care
- Smoking cessation services
Additionally, during the first 12 months of your Part B enrollment, you can receive a “Welcome to Medicare” preventive visit. This visit allows you to review your medical history with your doctor and learn about the preventive services that are suitable for you.
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- Preventive services: Medicare Part B covers various preventive services to help detect and prevent illnesses before they become serious. These services are designed to keep you healthy and address potential health risks. Examples of preventive services covered by Part B include screenings for certain diseases, vaccinations, and wellness visits.
What’s not covered under Medicare Part B?
Original Medicare, which includes Part A and Part B, does not cover all medical services. Part A and Part B generally do not cover:
- Long-term care, such as nursing home care
- Most dental care
- Eye exams for eyeglasses
- Dentures
- Cosmetic surgery
- Hearing aids (including exams for fitting them)
- Routine foot care like trimming, cutting, or clipping nails
- Most prescription medications
- Medical care outside the United States
To address these gaps in coverage, Medicare Supplement plans (Medigap), including Part D for prescription medication coverage, can help fill the void. Additionally, Medicare Advantage plans (Part C) offered by private insurance companies can provide extra benefits beyond Original Medicare, such as routine dental and vision coverage, hearing benefits, and prescription drug coverage.
Who is eligible for Medicare Part B?
You are eligible for Medicare Part B if:
- You are 65 years of age or older
- You have certain disabilities (if you are under 65)
- You have end-stage renal disease (if you are under 65)
When can you enroll in Medicare Part B?
Some individuals are automatically enrolled, while others need to sign up on their own. You will be automatically enrolled in Part A and Part B if:
- You are already receiving benefits from Social Security or the Railroad Retirement Board (RRB)
- You have a disability and receive Social Security disability benefits (your Medicare coverage starts in Month 25 in this case)
- You have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis)
If you are not automatically enrolled, you will need to sign up during one of these three enrollment periods:
- Initial Enrollment Period: This is a seven-month period that begins three months before you turn 65 and ends three months after you turn 65.
- Special Enrollment Period: This period occurs when your employer-sponsored coverage ends.
- General Enrollment Period: This period takes place from January 1 to March 31 each year.
Is it possible to delay enrolling in Medicare Part B?
Since there is a premium associated with Medicare Part B, you can choose to delay your coverage. Some individuals opt out of Part B if they are still working and have coverage through their employer or their spouse’s employer. In such cases, you can sign up for Part B up to eight months after your coverage or employment ends, without incurring a late enrollment penalty. This is known as your Special Enrollment Period.
If you miss this window, your monthly Part B premium may increase by 10% for each 12-month period that you could have had Part B but didn’t enroll. For example, if you delay signing up for Medicare for two years, you will pay a 20% premium penalty for as long as you have Part B.
You may also be subject to this additional fee if you miss your initial enrollment period and do not have employer-sponsored coverage at the time.
Medicare Part B cost
Medicare Part B involves premiums, a deductible, and coinsurance.
- Premiums: You need to pay the premiums every month, regardless of the care or services you receive. The standard monthly premium for Medicare Part B in 2023 is $164.90, but premium amounts can change annually.
- Deductible: Before Part B starts covering most of the services, you need to pay your annual deductible out of pocket. In 2023, the Part B deductible is $226.
- Coinsurance: For most medically necessary services covered by Part B, you are responsible for a 20% coinsurance. However, there is no coinsurance for most preventive care services. Your costs are limited to the 20% coinsurance if your doctor or provider accepts Medicare assignment, meaning they agree to the amount Medicare pays. Providers who charge more than the Medicare-assigned amount may bill you for the difference. It is essential to confirm with new healthcare providers if they accept the Medicare-approved payment amount.
Many individuals enrolled in Original Medicare purchase Medicare Supplement Insurance (Medigap) to help cover the out-of-pocket costs associated with Medicare Part B.
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