Medicare Part B

Part B generally covers inpatient care or medical attention delivered by a healthcare professional. Part A and B in conjunction form Original Medicare, which covers the benefits of both. Not as many people are automatically entitled to Part B when they turn 65. There is an enrollment process and a premium to pay for this coverage. If Medicare is your only insurance coverage, we highly suggest enrolling in Part B as Medigap cannot cover its benefits.

What Does Medicare Part B Cover?

Medicare covers 80% of approved costs under Part B after you first pay the annual deductible. It provides you access to a variety of outpatient medical services:

  • Physician care
  • Healthcare professionals
  • Lab tests
  • Therapies
  • Some medical equipment
  • Medications provided incident to doctor services
  • Some chiropractic care
  • Ambulance Rides

Part B also covers some preventive care and screenings for which there is no cost-sharing including:

  • Flu Shots and other immunizations
  • Colonoscopies
  • Mammograms
  • Bone mass measurements

Part B also covers more expensive services :

  • Radiation or chemotherapy for cancer
  • Surgeries
  • Diagnostic imaging
  • Dialysis

How Much Will I pay for Medicare Part B?

You must pay a monthly premium for your Medicare Part B benefits. The majority of Americans will pay the standard monthly amount set by the government. In 2018, the base rate for Part B is $134/month for people new to Medicare. However, Part B is income-adjustable meaning you will have to pay more if your income is above a certain amount.

How Do I Sign Up for Medicare Part B?

If you already receive Social Security or Railroad Board income benefits at age 65 do not need to enroll. The Social Security office will automatically enroll you. Your card will arrive in the mail 1 – 2 m months before your 65th birthday.

Everyone else needs to apply for Medicare Part B themselves. The enrollment period for this begins three months before the month you turn 65 and ends 3 months after your birthday month. You can apply for Medicare Part B online, over the phone or in person at your local Social Security office. It will take 2 – 3 weeks before your card arrives, so you should plan to apply several weeks prior to when you will need the coverage.

Failing to sign up for Part B during the enrollment period may result in a penalty cost. For more information about enrollment periods, click here.

What doesn’t Part B Cover?

Medicare Part B covers usually anything that is deemed medically necessary. So if a doctor documents your need for a certain procedure, it will usually be covered. 95% of all claims are paid, but if Medicare disagrees with the medical necessity of a treatment, you may need to submit further documentation.

Here are some treatments not covered by Part B:

  • Routine dentist
  • Orthopedic shoes
  • Routine eye care
  • Some vaccines
  • Syringes and insulin

It also does not cover drugs that you pick up yourself at a retail pharmacy. For those, you will need a Part D drug plan.

What is my Cost sharing under Medicare Part B?

You will pay a percentage of the costs of your medically-necessary Part B services. Generally, these costs are:

  • $183 Deductible
  • 20% coinsurance, with no limits or cap
  • any excess charges that a provider or facility may charge beyond what Medicare reimburses

For expensive procedures, the 20% you must pay for outpatient care can really add up. However, there are supplemental plans that can help cover these costs.

Get Help with Medicare Part B

There are two main ways to avoid catastrophic medical costs.

1) Medicare supplements are available for purchase to cover what A & B don’t.

2) Medicare Advantage plans offer A & B benefits through a private health insurance plan.