How Medicare Part B Works
Medicare Part B, or medical insurance, covers the costs of medical services and supplies for the diagnosis or treatment of a health condition. In addition, this policy covers outpatient and preventative services such as hospital visits and disease screenings.
Medicare Part A, by contrast, covers inpatient and hospital coverage. Medicare Part A and B combined, form Original Medicare. Following are essential facts policyholders need to know about Medicare Part B coverage in 2022.
What does Medicare Part B Cover?
Medicare Part B covers medical services and supplies your physician requires to treat a policyholder’s health condition. The following are examples of costs covered by Medicare Part B:
- Visits to a healthcare facility
- Ambulance services
- Part-time or temporary home health care
- Rehabilitation services and physical therapy
- Flu and hepatitis b shots
- Cardiovascular, cancer, and diabetes screenings
- Limited outpatient prescription drugs
- Durable medical equipment
- Clinical research
- Mental health services (inpatient, outpatient, and partial hospitalization)
- Second opinions before surgery
Medicare Part B will cover most preventative services if the patient visits a health care provider that accepts assignment. In addition, facilities that take assignments are paid directly by Medicare, ensuring approval and payment of supplies and services.
The Medicare Advantage Plan includes Part A and Part B coverage, offered through Medicare contracted private insurance companies. Advantage plans are legally obligated to provide the same benefits as Original Medicare. Additionally, Advantage plans may provide coverage typically excluded from the standard Part B policy. Such services could include dental, vision, hearing, and additional prescription drug coverage.
Eligibility for Medicare Part B 2022
Individuals who meet eligibility requirements for premium-free Medicare Part A coverage are automatically eligible for Part B coverage. Medicare Part A coverage is available for individuals over 65, people with disabilities, and those with end-stage renal disease. Medicare.gov offers an online tool to help determine Medicare eligibility. However, those who do not qualify for Medicare Part A coverage may still be eligible for Part B if they meet one or more of the following criteria:
- 65 years of age or older
- Paid Medicare taxes for the past ten years
- S. citizen or lawful permanent resident
- Currently, receive disability benefits
Individuals with disabilities may automatically qualify for auto-enrollment in both Part A and Part B coverage. Individuals under the age of 65, receiving Social Security and Railroad Retirement Board disability benefits for 24 consecutive months, will automatically be enrolled for both Medicare plans. Those with amyotrophic lateral sclerosis disease may also qualify for Plan B coverage before the age of 65.
When to Enroll for Medicare Part B for 2022
It’s recommended to enroll for Medicare Part B for 2022 as soon as you’re eligible. Those receiving retirement benefits before the age of 65 and disability recipients are usually automatically enrolled for Medicare Part A and B when they become eligible.
How to Apply for Medicare Part B
For those who aren’t automatically enrolled, applications for Medicare are available at the Social Security office, visiting their website, or calling the toll-free number (1-800-772-1213). TTY users can contact 1-800-325-0778.
Typically, eligible recipients are invited to enroll during the initial enrollment period if they do not qualify for a special enrollment period. However, for those who miss both appointments, the annual General Enrollment Period, from January 1st to March 31st, offers another chance to join. Coverage would then begin starting July 1st. Keep in mind that late enrollment penalties may apply for not signing up during initial eligibility.
From the moment an individual turns 65 and obtains Medicare Part B coverage, there is a six-month window of opportunity to sign up for Medigap or Supplemental Medicare insurance. During this time, policyholders have a guaranteed-issue right to a Medigap plan without having to pay higher premiums as a result of a pre-existing health condition.
When to Delay Enrollment
Some people are eligible for premium-free Medicare coverage. However, many have to pay a monthly fee for Part B coverage. Therefore, it may be wise to delay enrollment for those already enrolled in an employer-sponsored group plan or those covered under a spouse’s plan.
Individuals who are still working should consult with their current health insurance provider to find out if their current plan can work with Medicare. Those who already have employer health coverage can sign up for Medicare during the annual enrollment period without paying a late fee. Once the employer’s health coverage ends, an individual has an eight-month grace period, in which a special, penalty-free enrollment period opens. Important to note is retiree policies and COBRA do not qualify an individual for a special enrollment period.
Premiums for Medicare Part B
How Much is Medicare Part B – How Much Does Medicare Part B Cost
Monthly premiums are based on an individual’s income as follows. A late enrollment penalty may apply to individuals who did not enroll in Medicare Part B as soon as they were eligible. In this case, monthly premiums can cost up to 10% more each year that a qualified individual does not enroll.
|Beneficiaries who file
individual tax returns with income:
|Beneficiaries who file
joint tax returns with income:
|Income-related monthly adjustment amount||Total monthly premium amount|
|Less than or equal to $88,000||Less than or equal to $176,000||$0.00||$148.50|
|Greater than $88,000 and less than or equal to $111,000||Greater than $176,000 and less than or equal to $222,000||59.40||207.90|
|Greater than $111,000 and less than or equal to $138,000||Greater than $222,000 and less than or equal to $276,000||148.50||297.00|
|Greater than $138,000 and less than or equal to $165,000||Greater than $276,000 and less than or equal to $330,000||237.60||386.10|
|Greater than $165,000 and less than $500,000||Greater than $330,000 and less than $750,000||326.70||475.20|
|Greater than or equal to $500,000||Greater than or equal to $750,000||356.40||504.90|
|Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses:||Income-related monthly adjustment amount||Total monthly premium amount|
|Less than or equal to $88,000||$0.00||$148.50|
|Greater than $88,000 and less than $412,000||326.70||475.20|
|Greater than or equal to $412,000||356.40||504.90|
In addition to monthly premiums, policyholders shouldn’t forget the yearly deductible of $183. Individuals may also be responsible for a copayment regarding specific outpatient services. Typically, a policyholder will then pay 20% of approved medical services. Medicare Part B will then pay the remaining 80%.
Medicare Part B Deductibles
What is Medicare Part B Deductible?
For some services covered by Medicare Part B, policyholders will have to pay an annual deductible. Yearly deductibles for Part B in 2021 are $203. Additionally, policyholders often must pay 20% of the Medicare-approved amount out-of-pocket before Medicare coverage takes over.
Supplemental coverage, such as Medicaid, Medigap plan C or F, and employer-sponsored plans can help pay deductibles. However, Medigap plans were only sold through 2019. Therefore, starting in 2020, Medigap plans covering the Part B deductible were no longer open for enrollment. Those who already have Medigap coverage, however, will not lose their coverage.
The elimination of Medigap plans resulted from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). To steer away from quantity-based systems and improve the quality of senior care, this new legislation is encouraging more out-of-pocket spending from policyholders.
Medicare Supplemental Insurance
Original Medicare policyholders can get help paying for deductibles by signing up for Medigap insurance. Ten Medigap plans were available in 2019, with plans C and F covering the cost of the Part B deductible. However, Massachusetts, Minnesota, and Wisconsin Medigap plans are standardized differently, so policyholders in these states should review local regulations.
Medigap plans range in price, depending on the insurance provider. To find the best price, policyholders should reach out to a licensed insurance agent and compare programs before making a final decision. A different type of Medigap policy, known as Medicare SELECT, is available as an alternative in a few states. This plan only covers medical care from a healthcare facility included on a list of approved partner physicians.
Medicare Part B covers outpatient and medical services, usually in combination with Medicare Part A, including inpatient and hospital services. With a Medicare Advantage Plan, policyholders can gain coverage not typically offered by Part B, such as dental, vision, and hearing policies.
Those over the age of 65, receiving disability benefits, or suffering from renal disease are eligible for Medicare Part B coverage. Many times, individuals will be enrolled automatically. If not, they should consult with their local Social Security office and health insurance provider. In addition, it may be sensible to delay enrollment if an individual is still enrolled in an employer-based insurance program.
Premiums start at $134 and range according to individual income levels. Annual deductibles of $203 can be avoided by signing up for Medigap or another Medicare Supplemental Insurance program. Medigap programs that pay Part B deductibles have been discontinued.