Medicare Part B - UrMedicare

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What is Medicare Part B?

It’s the part of Medicare that helps cover medically-necessary services and preventive services to help keep you healthy. Services like these are provided by doctors, other health care providers, or suppliers. Part B also covers some physical and occupational therapy, as well as some home health care.

What Does Medicare Part B Cover?

Medicare Part B provides coverage for a variety of outpatient medical services. These services can include preventive care, like flu shots and colonoscopies, as well as more common things like doctor’s visits and lab testing. Part B also covers home health care, ambulance rides, and some chiropractic care.

In addition, Medicare Part B covers services that are sometimes needed in the hospital, such as physician’s services, radiation or chemotherapy for cancer, surgeries, diagnostic imaging, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump.

Otherwise, outpatient drugs fall under Part D. Part B is optional, but if Medicare is your primary coverage, you will need Part B in order to get Medigap supplemental coverage.

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

Medicare Part B pays for 80% of approved costs after you first pay the annual deductible.

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 2022, the base rate for Part B is $170.10/month for people new to Medicare. However, you may owe more if your income is above a certain level.

You can find a chart showing the costs based on your income bracket on our Medicare costs page. If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.

Medicare will deduct your Part B premiums out of your Social Security check if you are already enrolled in your SS income benefits. If not, they will bill you quarterly. There is a credit card option at the bottom of the quarterly invoices. To pay for Part B by credit card, just complete the bottom portion of the payment coupon and mail it into the Medicare Premium Collection Center.

You also have the option to use Medicare Easy Pay, a free auto-draft service that will deduct your premium payments monthly from a checking or savings account.

How do I sign up for Medicare Part B?

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

Everyone else needs to apply for Medicare Part B themselves at age 65. Applying for Medicare Part B can be done online, over the phone or in person at your local Social Security office. After you apply, it will take 2 – 3 weeks before your card will arrive, so you should plan to apply several weeks prior to when you will need the coverage.

As you can see, it’s easy to sign up for Part B. It’s important to enroll in Part B during your Initial Enrollment Period unless you have other creditable coverage. Otherwise you would be subject to a penalty!

For more information on each of these application options, visit our Apply for Medicare page.

Does Medicare Part B Cover Everything Outpatient?

Part B of Medicare usually covers anything that is medically necessary. If your doctor documents that you need a certain procedure, it will most likely be covered by Part B. However, if Medicare disagrees with your doctor on what is medically necessary, there might be some additional documentation required.

What Doesn’t Part B Cover?

Part A of Medicare covers hospital expenses, so Part B does not. Additionally, Part B does not cover cosmetic procedures, routine dental or vision care, routine foot care, or drugs that you pick up yourself at a retail pharmacy. For those things, you will need a Part D drug plan.

In general, Part B of Medicare does not cover anything that is not reasonable and necessary. Your doctor usually will know the rules for what is covered and what isn’t.

What is Cost Sharing Under Medicare Part B?

Original Medicare (Part A and Part B) pays for many, but not all, of the health care services and supplies you need. You are responsible for paying some of the costs associated with Original Medicare through deductibles, coinsurance, and copayments.

Part B has an annual deductible of $183 in 2020. After the deductible is met, you generally pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment.

What is the Medicare Part B Late Enrollment Penalty?

If you failed to sign up for Medicare when you were first eligible, and you didn’t have any creditable coverage, you will be subject to the Medicare Part B late enrollment penalty. This penalty is equal to 10% per year for every year (12 full months) that you waited to enroll.

When you do finally enroll, you’ll need to wait for the Medicare General Enrollment Period to sign up for Part B. This period runs from January 1st to March 31st each year. Your benefits will then begin the following July. This can be a double whammy because not only do you now owe a penalty, but you have to wait several months for your coverage to kick in.

If you enrolled late because you’ve had employer group health coverage from a company with 20 or more employees, you will not be subject to the Part B late enrollment penalty. When you leave that coverage, you have 8 months to sign up for Part B. This is your Special Enrollment Period for Medicare.

The best way to avoid the Medicare Part B late enrollment penalty is to enroll in Medicare during your Initial Enrollment Period. You can learn more about Medicare enrollment periods here.

Get Help with Medicare Part B

There are a few things you should know about Medicare Part B. First, it is important to have health insurance. This can protect you from high medical bills in the event of an accident or illness. There are two main ways to get this coverage: through Medicare supplement plans or Medicare Advantage plans. Supplement plans cover the parts that A & B do not, while Advantage plans are an option if you are open to getting your A & B benefits through a private health insurance plan.

Read more about buying a Medicare Supplement or enrolling in a Medicare Advantage plan. You can also contact us for a free consultation at (317)-536-8565 today. Our experts can help you compare the options, explain your Medicare Part B coverage, and find the most suitable plan for you.