Medicare is a low-cost health insurance plan with extensive and diverse coverage, which makes it a must-have for seniors 65 and older. It has four parts and can be purchased separately. These are Medicare Part A, Part B, Part C, and Part D.
Medicare Part B is the other half of Original Medicare. It covers annual wellness visits, laboratory tests, bloodwork, x-rays, medical equipment, mental healthcare, and ambulance services.
Which Services Does Medicare Part B Cover?
Medicare Part B in general covers, but is not limited to, next services:
- Visits to the doctor`s office
- Preventive services
- Physical therapy
- Chemotherapy
- Flu shots
- Pneumococcal shots
- Outpatient mental health care
- Diabetes screenings, supplies, and self-management therapy
- Alcoholism counseling
- Durable Medical equipment
Medicare Part B Costs
Under Part B insurance, in most cases, you will pay 20% of the Medicare-approved amount for each item or service you choose to receive. It does not cover hearing aids or glasses, DHV (dental, hearing, and vision) exams, emergency assistance outside U.S., long-term care, and Prescription drug coverage. Medicare Part B requires you to pay a monthly premium.
Medicare Part B Premium
The monthly premium is assigned on an individual basis taking into account your adjusted gross income together with a yearly deductible before coverage begins. The standard monthly fee for Part B is $164.90 in 2023. It is higher for recipients who have higher incomes. This is called IRMAA or Income Related Adjustment Amount. How much you pay depends on your income from the tax return from 2 years ago. However, in 2023, Part B IRMAA is going down by 3% in comparison to 2022.
Other Costs
Your costs if you enroll in Medicare Part B will all together include the Part B monthly premium, copay, coinsurance (part of the cost that Medicare does not pay), and the yearly deductible.
The annual deductible for Part B is $226 in 2023. In addition, the patient pays 20% of the bill as a coinsurance payment and a copay amount which is set by your insurer.
Medicare Part B Enrollment
All Medicare Part A users are also entitled to enroll in Part B. An aged person not entitled to Part A may enroll in Part B if is 65 years old or over and is either a U.S. citizen or lawfully admitted for permanent residence who has resided in the United States continuously for 5 years in a row.
A person who is automatically enrolled in Medicare Part A is also automatically enrolled in Part B. However, because of the mandatory premium for Part B coverage that must be paid, they have the option of turning it down.
Medicare Enrollment Periods
- Initial Enrollment Period
A seven-month period during which you can sign up for the first time. This period starts three months before your 65th birthday and lasts during the month of your birthday and the three months after your 65th birthday.
- Annual Open Enrollment Period
In case you already have Medicare coverage but want to make changes you can do so during the Annual Open Enrollment Period from October 15 to December 7.
- Special Enrollment Periods
You qualify for a special enrollment period if you have health insurance through your employer of more than 20 people. This enrollment period allows you to enroll once you lose the coverage or are no longer employed.
If you enroll during the eight months of your special enrollment period, you do not have to pay a late enrollment penalty.
- General Enrollment Period
If you miss the Initial or Special enrollment period you have another chance to apply for Part A and Part B during the General Enrollment Period from January 1 to March 31.
Medicare Part B Late Enrollment Fees
You can enroll in Medicare at different times, depending on your plan. Each enrollment period has unique rules about when to apply and when your benefits will kick in.
In case you miss the opportunity to enroll during the defined enrollment periods, you will have to pay late fees.
Medicare Part B’s late enrollment penalty adds 10% of the standard premium rate for each 12-month period you went through without signing up. This lasts as long as you hold Part B coverage.
Medicare Part B Excess Charges
Most health providers accept Medicare Assignment so Medicare Part B Excess Charges are rare but they are possible in the case of a health provider who accepts Medicare but doesn’t accept Medicare payment as payment in full. In that case, beneficiaries can be billed for Part B excess charges of 15%.
Medicare Part B is a part of Original Medicare which covers 80% of the services. In general, you must pay the other 20% for the services if the provider accepts Medicare Assignment, but if they don’t, you will pay that additional 15% alongside that 20%.
Craig W. Hansen is an insurance professional and co-founder of William & Michael Advisor Group LLC and Jersey Insurance Solutions. Craig has served his clients in many facets of the insurance industry, always with the same goal: excellence in service while building solid, long-term, lasting relationships. With over a decade of experience in the insurance benefits industry, Craig’s clients know they can call on him anytime and receive platinum service with a smile.
