Medicare Part B is the elective coverage offered under Original Medicare. The medical insurance offered by Part B complements the expenses that Part A does not cover. To help you assess whether this type of insurance is right for you, we have outlined some of the basic information about the covered expenses, eligibility, pricing, and other considerations for Medicare Part B.
Medicare Part B covers the cost of many kinds of medical appointments. This includes annual wellness visits, doctor’s visits, and physical therapy sessions. Prescription drugs you are given in a clinical setting are also covered by a Part B policy. While outpatient care expenses like wheelchairs and walkers are paid for through Medicare Part B, prescriptions you take at home are not. Part D prescription drug coverage is required for medications not administered at a hospital or other medical facility.
It can be tricky to identify which in-hospital expenses are covered by which part of your Original Medicare plan. The table below lists specific medical expenses that fall under Part B. It’s still a good idea to confirm with your insurance provider whether a particular piece of your health care falls under your Medicare Part B coverage if you aren’t completely sure.
Medicare Part B covers doctor visits and outpatient care, including:
Doctor visits, including when you are in the hospital
Diabetes screenings, education, and certain supplies
An annual wellness visit and preventive services, like flu shots
Mental health care
Clinical laboratory services, like blood and urine tests
Durable medical equipment for use at home, like wheelchairs and walkers
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Ambulatory surgery center services
Some health programs, like smoking cessation and obesity counseling
Ambulance and emergency room services
Physical therapy, occupational therapy and speech-language pathology services
Medicare Part B covers doctor visits and outpatient care, including:
Doctor visits, including when you are in the hospital
Diabetes screenings, education, and certain supplies
An annual wellness visit and preventive services, like flu shots
Mental health care
Clinical laboratory services, like blood and urine tests
Durable medical equipment for use at home, like wheelchairs and walkers
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Ambulatory surgery center services
Some health programs, like smoking cessation and obesity counseling
Ambulance and emergency room services
Physical therapy, occupational therapy and speech-language pathology services
Since Part B is a component of Original Medicare, the eligibility requirements are largely the same as those of Part A. Most Medicare Part B enrollees must be aged 65 or older and have lived continuously in the United States for the past 5 years. Individuals with end stage renal disease (ESRD), ALS/Lou Gehrig’s Disease, or who are receiving disability payments may be eligible for Part B coverage before the age of 65. To confirm your eligibility, schedule a free consultation with a Senior Insurance Advisors expert or visit the Medicare website’s eligibility questionnaire.
Many people do not have to pay a premium for their Part A coverage, but everyone must pay for Part B coverage if they choose to carry it. In 2022, the standard monthly premium for Medicare Part B totals $170.10. This number may vary based on your income and can be adjusted if your financial situation or life changes significantly. People who file amended tax returns or experience a qualifying life-changing event can appeal their Part B premium determination.
If you are married, your joint income is used to calculate your monthly premium. It’s important to note, however, that each spouse is responsible for paying their own Part B premium separately. For your convenience, the Social Security Administration and Railroad Retirement Board automatically deduct your Part B premiums from your monthly checks. If you are not receiving benefits from either of these agencies, your provider will simply send a bill every 3 months.
Generally, there is a penalty assessed for enrolling in Medicare Part B outside of your Initial Enrollment Period at age 65. If you are still working at the time of your IEP, you may be concerned about having to choose between higher Part B premiums later in life and keeping the health insurance coverage offered by your employer. Medicare does make an exception for people who are still working at 65 to avoid penalizing late enrollees unnecessarily.
It’s important to confirm whether your policy is considered creditable health insurance or not. If you are employed at the time of your IEP and hold a qualifying policy through your employer, you will not be assessed any financial penalties when you do finally enroll in Medicare Part B. In fact, Medicare offers an 8-month Special Enrollment Period for Part B coverage that begins when you stop working or otherwise lose employer-provided coverage.
At Senior Insurance Advisors, we know you have important decisions to make when it comes to Medicare Part B, or any other component of your health insurance. We strive to be your trusted partner in all things Medicare. We encourage you to reach out with any questions you may have! We would love the chance to sit down and talk through your needs, at absolutely no cost to you.
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