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Your Complete Guide to Medicare Part B Coverage

Medicare health insurance part B

Medicare is a federal government insurance program for people age 65 and older and certain other groups. It is divided into several sections, one of which is Part B. 

Medicare Part B is the component of Medicare that offers medical insurance. It applies to a variety of outpatient services. Read on to learn more about Part B, including what it covers, how much it costs, and when to enroll. 

What is Medicare Part B Coverage, and what does it cover?

Medicare Part B, along with Part A, constitutes what is known as original Medicare. It is estimated that in 2016, 67 percent of individuals using Medicare were enlisted in Original Medicare. 

Part B protects a wide range of medically necessary outpatient services. A service is considered medically necessary if required to diagnose or treat a medical condition effectively.

Part B services include the following:

  • emergency ambulance transportation
  • durable medical devices such as walkers, wheelchairs, and oxygen equipment
  • chemotherapy
  • kidney dialysis 
  • emergency room care
  • laboratory testing, such as urinalysis, pop smears, and blood tests 
  • other testing services, such as echocardiogram and imaging tests 
  • occupational therapy
  • transplants
  • physical therapy
  • outpatient hospital and therapeutic services
  • durable medical devices, such as oxygen tanks
  • some home health services
  • Chiropractic services for spinal subluxation
  • prescription medications, such as those given intravenously or by a doctor

Part B also includes some preventative care services. Here are some examples:

  • Cancer screenings such as those for colorectal, breast, and prostate cancers 
  • Colonoscopy
  • X-rays
  • Smoking cessation counseling
  • Preventive mammograms for women
  • Diagnostic mammograms for men and women
  • Women’s and men’s diagnostic mammograms
  • Screenings for cardiovascular disease
  • Bone density measurements
  • Screening tests for depression and glaucoma
  • Diabetes examinations
  • Hepatitis B, C, and HIV screenings 
  • Sexually transmitted infection (STI) 
  • Screening vaccinations for Influenza, Hepatitis B, and Pneumococcal disease

What Services does Part B not cover?

Medicare Part B does not cover all services. If you want these services, you must pay for them out of pocket. Here are a few examples:

  • routine physical examinations
  • most prescription drugs 
  • dental care, including dentures
  • prevalence of vision care, including eyeglasses or contact lenses hearing aids
  • cosmetic surgery
  • long-term care
  • complementary health services such as acupuncture and massage
  • If you want prescription coverage, you can buy Part D plans. Medicare Part D programs are provided by private insurance organizations and cover most prescription drugs.

Furthermore, Medicare Part C (or Medicare Advantage) programs include all benefits covered under traditional Medicare services and some additional services such as vision, dental, and even fitness plans. If you think you’ll need these medical services, consider a Part C program. 

Who Qualifies for Medicare Part B?

Typically, the following groups are eligible for Medicare Part B:

  • those age 65 and above
  • those with disabilities
  • individuals suffering from end-stage renal disease (ESRD)

When an individual first becomes eligible for the Medicare plan, they must qualify for premium-free Part A to be eligible for Part B. Because individuals often pay Medicare tax bills while working, most applicants are qualified for a premium-free Part A plan. They can also sign up for Part B when they become eligible for Medicare for the first time. 

If you need to purchase Part A coverage, you can still register in Part B. You must, however, meet the following criteria:

  • have reached the age of 65
  • be a resident of the U.S. for at least five years, either as a citizen or the legal permanent resident

What are the Exceptions to the Medicare Part B Eligibility Rules?

To get Medicare Part B coverage, it’s not necessary that you must be age 65 or above.

  • You qualify for Part B coverage if you are under 65 and have received railroad retirement disability benefits or Social Security disability benefits for at least 24 months.
  • People of any age who have ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis) are eligible for Medicare Part B.

What will Medicare Part B Cost in 2022?

Let us take a look at each of the expenses associated with Medicare Part B in 2022.

Monthly Premium

Your monthly insurance premium is the amount you pay for Part B coverage each month. The standard Part B monthly premium for 2022 is approximately $170.10.

Higher-income individuals may be required to pay higher monthly premiums. Your annual income is calculated using your tax return from two years ago. So this is your 2020 tax return for 2022.   

There is also a late enrollment penalty, which can affect your monthly Part B premium. You would be responsible for this if you did not sign up for Part B when first eligible.

When you are required to pay the late enrollment penalty, your monthly premium can increase by up to 10% of the standard premium for each twelve-month period in which you were eligible for Medicare Part B but didn’t sign up. You will be liable for this as long as you are enrolled in Part B.

Deductibles

The insurance deductibles are the amount of money you must pay out of pocket before Part B begins to cover your services. In 2022, the deductible for Part B coverage is around $233. 

Coinsurance

Coinsurance is the percentage of a service’s cost that you pay out-of-pocket after you’ve met your deductibles. This is typically 20% for the Part B coverage. 

Copays

A copay is a predetermined amount you need to pay for a service. Medicare Part B does not typically include copays. However, in some circumstances, you may be required to pay directly. As an example, suppose you use a hospital’s outpatient services. An example is if you use medical outpatient services.

Maximum Limit for Out-of-Pocket Expenses

An out-of-pocket maximum is a yearly limit on how much you need to pay out-of-pocket for covered medical services. Original Medicare doesn’t have any limit for out-of-pocket maximum.

When can I Register for Medicare Part B?

Some individuals are automatically registered in traditional Medicare, while others will need to apply. Let’s dig deeper into this.

How to Enroll in Medicare Part B Automatically?

Original Medicare plan enrolled the following groups automatically:

  • Those turning 65 and already receiving retirement benefits from the RRB (Railroad Retirement Board) or SSA (Social Security Administration)
  • Individuals under 65 with disabilities and receiving disability benefits from the RRB or SSA for 24 months 
  • People with ALS (amyotrophic lateral sclerosis) who are obtaining disability benefits

It’s worth noting that even though you will be automatically registered in Part A, Part B is entirely optional. You can postpone Part B coverage if you want to do so. This could happen if another program already covers you through an employer or a spouse.

Who needs to get register?  

Note that not everyone qualified for original Medicare will be registered automatically. Some will need to register with the SSA office:

  • Those turning 65 who are not currently receiving retirement benefits from the RRB or SSA can enroll three months before their 65th birthday.
  • People with ESRD can register at any time; however, the start date of your coverage might vary.

When can I submit my application?

Initial Enrollment Period or IEP 

This is a 7-month period around your 65th birthday when you can enroll in Medicare. It begins three months before your birth month includes your birthday month, and lasts three months after your birthday. During this period, you can enroll in all aspects of Medicare without paying the penalty.

Open Enrollment Period or OEP (October 15-December 7) 

During this period, you can switch from traditional Medicare (Part A & Part B) to Part C (Medicare Advantage) or from Part C to original Medicare. You can also change Part C plans or modify, add or remove Part D plans.

General Enrollment Period (January 1 to March 31)

If you did not register in Medicare coverage during your initial enrollment period, you might do so during this time. 

Special Enrollment Period or SEP

If you delayed enrolling in Medicare for an approved reason, you could enroll later during a Special Enrollment Period. You have eight months from the end of your health plan or your employment to sign up for coverage without penalty. 

Summary

  • Medicare Part B is the division of Medicare that provides medically necessary outpatient facilities. It also includes some preventative care services. It is a component of traditional Medicare.
  • Part B is available to people age 65 and older who have a disability or ESRD. The expenses of Part B coverage include deductibles, premiums, and copays or coinsurance are all part of the costs. Medicare Part B won’t provide specific services such as essential health benefits. So, you need to pay out-of-pocket for these expenses.
  • It’s in the default settings that most people are enrolled in original Medicare by default. Some will be required to register with the Social Security Administration. For these applicants, it’s essential to pay attention to these enrollment deadlines.