Those at least 65 years of age and some younger people with qualified disabilities are entitled to receive basic insurance benefits from Medicare Part A and Part B (Original Medicare). Original Medicare is the primary insurance for those that do not enroll in Medigap or Advantage (Part C) plans.
Medicare Part B is Original Medicare’s coverage for routine and preventative medical services, including visits to a primary care doctor or seeing a specialist. This guide will break down the basics of Part B that beneficiaries need to know to get the most from Medicare benefits.
When to Enroll in Medicare Part B
The best time to enroll in Part B is during the Initial Enrollment Period (IEP). The IEP opens three months prior to the month a beneficiary turns 65. It closes three full months after they turn 65, giving them seven months to enroll without penalty or special approval.
Note that it’s impossible to enroll in Part A for hospital coverage without first enrolling in Part B.
Can I Delay Part B Enrollment?
It’s important to enroll in Part B during the IEP unless one has credible medical insurance through a current employer. If coverage through an employer is lost, there is an eight-month period to enroll in Original Medicare. Those that enroll within that eight-month period, known as a Special Enrollment Period (SEP), may pay no penalties.
Those with TRICARE or CHAMPVA coverage are required to enroll in Medicare Part A and B when eligible, assuming they qualify for premium-free Part A. If they don’t qualify for premium-free Part A, then they do have the option to delay enrollment in Original Medicare.
Failure to enroll in Medicare Part B during the IEP, without qualifying for a SEP, can result in two consequences:
- Enrollment may only be possible in the General Enrollment Period that occurs from January 1st to March 31st each year.
- Enrollment may come with a late enrollment penalty, which increases the Part B monthly premium for the life of the policy.
Do you need more help deciding if you should enroll in Medicare Part B? We recommend using the enrollment fact sheet provided by CMS for free.
Does Enrolling in Part B Cost Money?
All Medicare beneficiaries are required to pay a monthly premium, but you aren’t charged at the time of enrollment. Either your premium is deducted automatically from your Social Security benefit payment, or you receive a bill for the premium when it’s due. For more information visit Medicare Parts A and B Costs.
Who Qualifies for Medicare Part B?
Most Americans qualify for Medicare Part B when they turn 65 years old. Some may qualify at a younger age due to disability or a diagnosis of end-stage renal disease. Qualification for Part B isn’t income dependent, though income can determine how much is paid for premiums.
What Does Medicare Part B Cover?
Medicare Part B is often referred to as “medical insurance” because it covers the charges associated with routine healthcare visits to primary care or specialist providers. It’s designed to cover all “medically necessary services,” which includes services needed to diagnose and treat most medical conditions. Some preventive services are covered as well.
Services covered by Medicare Part B include:
- Diagnostic services
- Treatment services
- Laboratory testing
- Clinical research
- Medical equipment
- Ambulance services
- Mental health services
Some services are covered partially through Medicare Part A and Part B. For instance, Part A and Part B policies offer some coverage for inpatient mental health services. Other than those exceptions, it’s helpful to think of Part B as everyday routine coverage and Part A as hospital and emergency care coverage.
Limitations of Part B Coverage
The following are not covered under Medicare Part B:
- Eyeglasses or contacts
- Vision exams
- Dental care
- Dentures or dental implants
- Routine foot care
- Hearing tests
- Hearing aids
- Cosmetic surgery
- Naturopathic services
- Prescription drugs
Prescription drugs are covered by Medicare Part D. Securing an Advantage plan under Medicare Part C may cover dental, vision, hearing, and prescription drug coverage along with all Original Medicare (Parts A and B) entitlements.
Medicare Part B Costs
We’ve touched on the Medicare Part B premium and potential late penalties. Now it’s time to go into more detail on the full costs of Part B. Once enrolled, you can expect the following out-of-pocket charges:
- A monthly premium
- An annual deductible
The Part B premium amount is set every year by the federal government. The standard Part B premium amount in 2022 is $170.10. There are also income thresholds that require beneficiaries with more income to pay higher premiums. The premium amount is determined by modified adjusted gross income as reported on income tax two years prior. Payments may go over $500 a month for those in the highest income bracket.
The Part B deductible amount is also set every year by the government. In 2022, the Part B deductible is $233. After meeting the deductible, beneficiaries can expect to pay the remaining 20% of their medical expenses for most services. The remaining 20% is coinsurance, and the percentage paid can vary for some services. Common expenses like mental health and home health services are typically associated with 20% coinsurance.
How to Get Help with Part B Costs
Are you worried about keeping up with your premiums and coinsurance even after the Part B deductible is paid? You have some options to make it easier. One way to minimize the bills is to enroll in a Medigap policy. These Medicare supplement plans allow you to pay one monthly premium to eliminate some or all coinsurance bills. No Medigap policy can cover the premium for Part B, but they can help with other expenses that otherwise are out of pocket. If you have limited income, see if you qualify for Medicaid in your state. It will serve as secondary payer to Medicaid, picking up out-of-pocket expenses for you. Your state may have additional programs to help with Medicare expenses if your income is limited.
Medicare Part B Guidance You Can Trust
Enrolling in Medicare Part B marks an exciting time in your life. You’re officially entering the retirement phase, and so many things are changing. You want to make well-informed decisions that protect you for the rest of your life. Some of those decisions include when you enroll in Medicare Part B and whether you stick with Original Medicare or opt for a Medigap or Advantage plan.
If the decisions feel overwhelming or you have questions about your unique circumstances, contact us for individualized information. Our guides are well-trained and have the patience to walk you through the Medicare facts that are important to your healthcare.