What is Medicare Part B

What is Medicare Part B?

 Medical Insurance that helps pay for physician services, medical supplies, and other outpatient services that are not covered by Medicare Part A.

What does Part B cover?

  •  Doctors’ services
  • Outpatient hospital care
  • Laboratory tests
  • Outpatient physical therapy
  • Certain home health care, ambulance services, medical equipment and supplies

Other services that are covered by Part B are:

  •  “Welcome to Medicare” visit. An exam that is received within the first year of enrollment.
  • Annual “Wellness” visits with Primary Care Physician. All costs are covered and provides: a medical history, a health risk assessment, an evaluation of your physical condition, screening for cognitive impairment, including depression and it also includes a personalized prevention

Please note that both the Welcome to Medicare and the Annual Wellness visits are NOT routine physical exams, but that they do both provide an opportunity to talk with a Primary Care Physician about any health concerns.

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screening and counseling
  • Behavioral therapy for cardiovascular disease
  • Bone mass measurement
  • Cardiovascular disease screenings
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • Diabetes self-management training
  • Flu shots
  • Glaucoma tests
  • Hepatitis B shots
  • HIV screening
  • Mammograms (screening)
  • Obesity screening and counseling
  • Pap test/pelvic exam/clinical breast exam
  • Pneumococcal pneumonia shot
  • Prostate cancer screening
  • Sexually transmitted infection screening (STIs) and high-intensity behavioral counseling to prevent STIs
  • Smoking cessation

What does Part B not cover?

Original Medicare, or Parts A & B do not cover:

  • Routine Physicals
  • Dental
  • Vision
  • Hearing
  • Exams and Glasses
  • Podiatry
  • Cosmetic Surgery
  • Acupuncture
  • Care outside of the United States unless it is an emergency

Please note: that if a procedure is considered to be “medically necessary” then coverage by Medicare will be allowed. An Example:

Mary had surgery to replace a detached retina that her Physician prescribed as medically necessary. Not only was the procedure covered by Medicare, but her prescription glasses (one pair) were too.

Again, as long the procedure is “medically necessary” then Medicare will cover it.

How to enroll into Medicare Part B?

 Enrollment is somewhat the same as it is for Part A. Once you are eligible and if you are collecting Social Security benefits enrollment into Medicare Part is automatic.

Please keep in mind that there are premiums associated with Part B, unlike Part A, so if you are still working you may want to decline coverage until officially retired. Declining is simple as all that is needed to do is contacting the Medicare offices.

For those who are not collecting Social Security enrollment, are 65 years or older and are not covered by credible health insurance through an employer or spouse’s employer enrollment is:

Initial Enrollment Period (IEP): 7 months that include the 3 months before the 65th birthday, the month of the 65thbirthday and the 3 months after.

Special Enrollment Period (SEP): the 8 months after your employment ends. Please note that Medicare does NOT recognize COBRA as credible health insurance.

For those that have missed both the IEP and the SEP, meaning enrollment was delayed or missed; the next available opportunity to enroll is between January 1 and March 31st of the current year.

What is the Late Enrollment Penalty?

For those that decided to wait past enrollment period and who did NOT have credible health coverage they can expect to see a penalty of:

The current premium plus 10% more for each 12 month cycle that coverage was delayed.

An example: Mary retires at age 68, but instead chooses to accept her employer’s COBRA health package for her health insurance and maintains this health coverage for 3 years.

At age 71 she has realized that Medicare does not recognize COBRA as credible health insurance and enrolls immediately into Medicare and Part B, which, currently, has a premium of $144.60.

Since she is considered to be a late enroller into Medicare for the past 3 years or 3 Medicare cycles she will also be hit with a penalty of an extra 30% of the current premium which will make her premium total to $187.98 a month.

Please note that the surcharge for the late enrollment penalty will be automatically deducted from any Social Security benefit she may be receiving and that this late enrollment penalty will continue to follow her for the rest of her life.

What are the costs associated to Part B?

 Premium: The standard national premium (everyone is charged the same amount unless of course someone has more money than another) in 2014 is $104.90.

Income Related Monthly Adjustment Amount (IRMAA): Medicare is means tested for income. For those who have higher than “average income” Medicare places surcharges on top of the Part B and Part D premiums. The 2020 IRMAA brackets are as follows:

If your income in 2018 is:  
Individual Couple Couple File Separately The Premium in 2014
$87,000 or less $174,000 or less $87,000 or less $144.60
$87,000 – $109,000 $174,000 – $218,000 N/A $202.40
$109,000 – $136,000 $218,000 – $272,000 N/A $289.20
$136,000 – $163,000 $272,000 – $326,000 N/A $376.00
$163,000 – $500,000 $326,000 – $750,000 $87,000 – $413,000 $462.70
>     $500,000 >     $750,000 >     $413,000 $491.60

Deductible:

$198.00 for 2020. Please note that in 2020, any new Medicare enrollees are not able, by law, to purchase a Supplemental Plan (Medigap) that will cover this deductible.

Coinsurance (Co-Pay)*:

 20% per occurrence where specified. This coinsurance is usually part of any coverage that includes a Physician visit, Surgical Supply and or Services and Durable Medical Equipment.

Excess Charges*:

 The amount that the care provider is allowed by Medicare to charge on top of the total of bill.

*Indicates that these costs can be covered by certain MediGap Plans

For more information please see medicare.gov.

Tags: , , ,

Related posts

What are Supplemental Plans?

What are Supplemental Plans?  Supplemental Plans, commonly referred to as “Medigap” Coverage are health...

The Hold Harmless Act

Through the “Medicare Catastrophic Coverage Act of 1988” Congress created a provision, the Hold...
Top