Medicare Part B

Intro

Medicare Part B covers health insurance coverage and forms part of Original Medicare. This part covers medical care and supplies within the scope of two types of services.

 

  • Medically Necessary Services: These comprise services or supplies required for the diagnosis and treatment of your condition, and comply with recognized standards of medical practice.
  • Preventive Services: Preventive health care that aims at preventing illnesses such as influenza, or the early detection of illnesses where treatment will work best.

 

All these can include:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health (Inpatient, Outpatient and Partial hospitalization)
  • Limited outpatient prescription drugs

 

Medicare Part B can also cover part-time or intermittent home health care and home rehabilitation services. In this, you can find such care as physical therapy, if a doctor has mandated it for the treatment of your condition.

 

Among the preventive care services which Medicare Part B covers are a one-off 'Welcome to Medicare' preventative visit, influenza and hepatitis B vaccinations, cardio-vascular screening, screening for cancer, diabetic screening and many more.

 

For a complete overview of the preventative care services falling under the coverage of Medicare Part B, consult the "Medicare and You" Medicare Handbook.

 

Suppose you have cover under a Medicare Advantage plan. In that case, you obtain both part A and part B of your Medicare coverage through a private health insurance plan that has affiliation with Medicare.

 

By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, and some plans include additional coverage not included in Original Medicare such as that for routine dental, vision, hearing, and even prescription drug cover.

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Medicare Part B - Eligibility

Anyone who qualifies for Medicare Part A is eligible for Medicare Part B by enrolling and contributing to the monthly premium. If you are ineligible for Medicare Part A, you may qualify for Medicare Part B by fulfilling the following requirements:

 

  • You must be aged 65 or older
  • You have to be a U.S. citizen
  • You have permanent residence, and who has resided legally in the United States for a minimum of five years uninterruptedly.

 

It is also possible for you to qualify for automatic enrollment in Medicare Part B because of disability.

 

When you are aged under 65 and receive disability benefits from the Social Security or Railroad Retirement Board (RRB), you are automatically enrolled in Medicare Part A and Part B coverage following completion of 24 months of disability benefits.

 

You may be eligible for Medicare Part B enrollment before the age of 65 if you suffer from either:

 

  • End-stage renal disease (ESRD) or
  • Amyotrophic lateral sclerosis (Also known as ALS or Lou Gehrig's disease)

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Suppose you retire or qualify for Medicare before the age of 65 because of a disability. In that case, you will generally automatically enroll in Medicare Part A and Part B once you are eligible.

 

However, if you do not enroll in the initial enrollment period, and you do not qualify for any special enrollment period, you can enroll in the annual General Enrollment Period.

 

This period runs from January 1 to March 31, and insurance protection commencing on July 1. There may be a late fee if you do not enroll when you are first eligible.

 

If you do not automatically enroll, you may apply for Medicare through Social Security:

  • In-person through a local Social Security office,
  • Via the Social Security website,
  • By calling 1-800-772-1213 (TTY user 1-800-325-0778) from 7:00 a.m. to 7:00 p.m. Monday through Friday.

 

Remember that after you turn 65 or older and have Part B health insurance, the 6-month Medigap open registration period commences.

 

Now is the perfect time for purchasing Medicare Supplement insurance plans. During your open enrollment period, you have the "guaranteed right" of buying any Medigap plan with no need to purchase medical insurance coverage or pay higher premiums because of a pre-existing condition*.

 

However, once you enroll in Medicare Part B, make sure you don't miss this one-time initial guaranteed enrollment period in Medigap.

 

*Pre-existing conditions are typically defined as health conditions which existed before the start of a policy.

 

They can restrict coverage, may be excluded from coverage or disqualify you for approval of a policy.

 

Actual definitions and applicable limitations or exclusions of coverage, therefore, will vary from plan to plan. Consequently, it is best to refer to the official documentation of a specific plan to determine how that particular plan addresses pre-existing conditions.

Some individuals may qualify for Part A of Medicare without paying a premium "premium-free." However, most individuals are required to contribute a monthly premium towards Medicare Part B of the plan.

 

Since there is a monthly premium for Part B health insurance. Some individuals may opt not to enroll during their initial enrollment period when they are presently being covered by an employer group plan (either by their employer or through an employer of their spouse).

 

However, should you continue to work, check with your health benefits administrator about how your insurance coverage will work together with Medicare?

 

Should you delay registering for Part B health insurance since you already have health coverage from your employer, you may register later, within a Special Enrollment Period. During this time, you will not pay a late registration penalty.

 

You can enroll in Part B of Medicare anytime provided you have group coverage from your existing employer's group plan.

 

After the end of your employer's health coverage or the end of your employment (depending on which comes first), there is a Special Enrollment Period of eight months during which you can enroll in Medicare Part B with no late penalty.

 

Remember that coverage for retirees and COBRA is not considered as health coverage based on current employment and does not qualify you for a Special Enrollment Period.

 

If you benefit from COBRA after your employer's coverage ends, you shouldn't wait until COBRA coverage expires before enrolling for Medicare Part B coverage.

 

The eight-month Special Enrollment Period for Medicare Part B commences directly following completion of your current employment or group plan (depending on which comes first).

 

This applies whether or not you are covered under COBRA.

Part B Medicare premiums are subject to change from year to year, and amounts payable can vary based on your circumstances.

 

For many individuals, the premium will be automatically deducted directly from social security benefits.

 

Part B standard monthly premium in 2020: $144.60.

 

Should your income be higher than a given amount, the premium can be higher as there are separate premiums for each income level.

 

If receiving benefits from Social Security, the Railroad Pension Board or federal retirement benefits, Part B premiums may be deducted directly from your regular monthly benefit. If not, you will be invoiced quarterly (every three months).

 

The following table outlines monthly Part B Medicare premiums according to your reported income two years earlier (2017 for this example).

 

The amounts are subject to change each year. There may be a late registration penalty applied if you did not register for Part B Medicare while you were eligible.

 

Monthly premiums can be 10% greater for every 12-month qualifying period you were eligible, yet failed to enroll in Medicare Part B.

 

Medicare Part B 2020 Monthly Premiums

You will pay

If your yearly income is

If you filed an individual tax return

If you filed a joint tax return

$144.60

$87,000 or less

$174,000 or less

$202.40

$87,001 – $109,000

$174,001 – $218,000

$289.20

$109,001 – $136,000

$218,001 – $272,000

$376.00

$136,000 – $163,000

$272,001 – $326,000

$462.70

$163,001 to less than $500,000

$326,001 to less than $750,000

$491.60

$500,000 or more

$750,000 or more

You pay

When you are married, but you file separate tax returns from your spouse, and your annual income is

$144.60

$87,000 or less

$462.70

$87,001 to less than $413,000

$491.60

$413,000 or more

Medicare Part B annual deductible is $198 in 2020; you will also be liable for a 20% coinsurance on many covered services.

 

When your doctor or health provider approves an assignment for any covered service, you will be responsible for the Part B deductible together with 20% of the Medicare-approved rate for the services rendered.

 

Accepting an assignment implies your doctor will not bill you above the Medicare-approved rate for the covered services. You will remain responsible for cost-sharing.

 

The information contained herein is not intended to be a complete description of the benefits. Contact your plan for further details.

 

Restrictions, co-payments and limitations may be applicable.

 

Please note, benefits are subject to change on January 1 of each year without prior notice.