As people age, they often rely more heavily on medical care. For individuals living in New Jersey, one of the ways they may access medical care is through Medicare Part B. Medicare Part B is an optional program that provides coverage for medical services and supplies that are necessary to diagnose and treat medical conditions. In this blog, we will answer some common questions about Medicare Part B in New Jersey.
What is Medicare Part B, and what does it cover?
Medicare Part B is a part of the federal health insurance program offered by the federal government that covers medically necessary services and supplies that are needed to diagnose and treat medical conditions. It is also known as medical coverage which provides a wide range of medical services and supplies, including doctor visits, outpatient care, preventive services, medical equipment, and some medications. It also covers certain preventive services, such as flu shots and cancer screenings. Coverage also includes annual physical exams, laboratory tests such as x-rays and blood work, durable medical equipment such as walkers, wheelchairs, etc., ambulance services, and mental health services.
What Medicare Part B Don’t Cover?
Medicare Part B doesn’t cover long-term nursing home care (more than a hundred days), dental care and dentures, drug prescription coverage, hearing aids, routine foot care, cosmetic surgery, acupuncture, and foreign travel emergency care.
How much does Medicare Part B cost?
The cost of Medicare Part B in New Jersey varies based on income. In 2023, the standard monthly premium for Medicare Part B is $164.90. However, individuals with higher incomes may pay more due to IRMAA. IRMAA stands for Income Related Monthly Adjustment Amount and it is calculated from your tax return from two years ago. This means that the determination of how much you will pay is based on your tax return from 2021. Additionally, some individuals may be eligible for financial assistance to help cover the cost of Medicare Part B like the Medicaid program.
Also, before you start receiving all of your Part B benefits you must meet your Part B annual deductible which is set at 226$ for 2023. After you meet the deductible Part B, you only need to pay 20% of the Medicare-approved amount since Original Medicare only covers 80%. The rest of the costs are your responsibility unless you have a Medicare supplement insurance plan which can help you cover gaps left by Part A and B.
When can I enroll in Medicare Part B?
Individuals can enroll in Medicare Part B in New Jersey during their initial enrollment period (IEP), which is usually the seven-month open enrollment period that begins three months before their 65th birthday and ends three months after they turn 65. If you miss your initial enrollment period, you may be subject to late enrollment penalties. Late enrollment penalty is an increase of 10% on your monthly premium amount for each 12-month period you were eligible for Medicare coverage but didn’t enroll. However, there are some situations where you may be eligible to enroll in Medicare Part B outside of your initial enrollment period, such as if you lose other creditable health coverage or if you move to a new area. If you meet these certain requirements you are eligible for a Special enrollment period (SEP). You can use the Part B SEP while you have job-based insurance, or for eight months after you no longer have employer group coverage or any other considered creditable coverage.
Make sure to read the How do I apply for Medicare Part B in New Jersey blog for a detailed guide through the enrollment process.
Can I change my Medicare Part B?
Yes, individuals switch from Original Medicare (Part A and B) in New Jersey during the annual open enrollment period, which is from October 15 to December 7 each year. During this time, you can change from Original Medicare to a Medicare Advantage plan or switch from one Medicare Advantage plan to another. You can also use this period to go back from Medicare Advantage to Original Medicare.
Do I need to have Medicare Part B if I have other insurance?
It depends on the type of insurance you have. If you have employer-sponsored insurance or other insurance that provides coverage that is at least as good as Medicare Part B, you may not need to enroll in Medicare Part B. However, if you have other insurance that does not provide sufficient coverage, you may want to enroll in Medicare Part B to ensure you have access to the medical services and supplies you need. In other words, if you are still working at 65 in a company that has more than 20 employees you may want to delay your Part B enrollment because your employer coverage is a primary source. But, if you work in a company that has less than 20 employees Medicare becomes your primary source of coverage so in that case it is good not to delay your Part B. If you delay Part B enrollment due to creditable coverage you are a good candidate for the Special enrollment period which means you can avoid paying a late enrollment penalty.
What are some additional benefits of Medicare Part B in New Jersey?
In addition to covering a wide range of medical services and supplies, Medicare Part B in New Jersey also provides access to a variety of resources and services that can help individuals stay healthy and manage their health conditions. For example, Medicare Part B provides coverage for diabetes self-management training and medical nutrition therapy. Medicare Part B also covers certain mental health services, such as outpatient counseling and therapy.
In conclusion, Medicare Part B can be a valuable resource for individuals in New Jersey who need medical care. It is important to understand what is covered by Medicare Part B, how much it costs when you can enroll, and whether you need to enroll if you have other insurance. Additionally, there are a variety of additional benefits and resources available through Medicare Part B in New Jersey that can help individuals stay healthy and manage their health conditions. By answering these common questions, we hope to have provided a comprehensive understanding of this part of Medicare coverage.
If you want to know more about Medicare Part B coverage in Rockaway area, you can check our blog post here.
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.
