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 2023.
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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.
Medicare Advantage Plans includes Part A and Part B coverage, offered through Medicare contracted private insurance companies. Medicare 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.
Eligibility for Medicare Part B
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. Individuals who must pay a premium for Part A must meet the following requirements to enroll in Part B:
- Be age 65 or older;
- Be a U.S. resident; AND
- Be either a U.S. citizen, OR
- Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for continuous years prior to the month of filing an application for Medicare.
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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
It’s recommended to enroll for Medicare Part B 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.
Most Medicare beneficiaries enroll during their Initial Enrollment Period, unless they qualify for a Special Enrollment Period due to specific circumstances. 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 Medicare Supplement 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
Everyone has to pay the Part B premium unless they qualify for a subsidy program.
Individuals who are still working should consult with their current health insurance provider to find out if their current plan can work with Medicare. Or, once the employer’s health coverage ends, an individual has an eight-month grace period, to enroll in Original Medicare. 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. 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.
In addition to monthly premiums, policyholders shouldn’t forget the yearly deductible of $226 in 2023. 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%.
According to the Centers for Medicare & Medicaid Services, the standard monthly premium will drop to $170.10 for 2023 Medicare.
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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. The annual deductible for all Medicare Part B beneficiaries is expected to drop to $164.90 in 2023. Additionally, policyholders often must pay 20% of the Medicare-approved amount out-of-pocket before Medicare coverage takes over.
Final Thoughts
Medicare Part B covers outpatient and medical services, usually in combination with Medicare Part A, which covers inpatient and hospital services.
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.
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