Medicare is comprised of four primary components: Part A, Part B, Part C, and Part D. These distinct segments of Medicare generally address specific medical services. Your Medicare coverage can be tailored to your needs by utilizing a combination of these parts, depending on your individual circumstances.
What does Original Medicare Part B cover?
While Original Medicare Part A takes care of significant aspects like hospital visits and skilled nursing care, it only covers a portion of your healthcare needs. Original Medicare Part B steps in to provide essential care for various other medical matters that require the attention of a doctor. Moreover, you have the flexibility to receive care from any healthcare provider who accepts Medicare patients.
Original Medicare Part B provides coverage for the following:
- Medically necessary physician services
- Outpatient care (including hospital-based outpatient services)
- Chiropractic care when medically required
- Home health services
- Mental health services
- Ambulance transportation
- Durable medical equipment, which may involve items like crutches, walkers, hospital beds, ventilators, and other non-hospital essentials
Additionally, Original Medicare Part B includes coverage for numerous preventive services (provided you meet the criteria based on age, gender, or risk factors). These preventive services may cover:
- Annual Wellness Visits
- Vaccines for influenza, COVID-19, hepatitis B, and pneumonia
- Screenings for diabetes, depression, and colorectal cancer
- Mammograms
- Bone mass measurements
- Pap tests and pelvic exams
What services fall outside the scope of Medicare Part B coverage?
If you’re uncertain whether a specific test, item, or service is covered, Medicare offers a user-friendly platform where you can verify your coverage status.
How much does Medicare Part B cost?
Medicare Part B Premiums
For the majority of Medicare beneficiaries in 2023, the monthly Part B premium stands at $164.90. However, your Part B premium could be higher depending on your income. If your modified adjusted gross income from two years ago surpasses a certain threshold, you’ll pay the standard premium plus an “Income Related Monthly Adjustment Amount” (IRMAA). To determine if this applies to you, refer to your previous income tax return, which contains your modified adjusted gross income.
In most cases, paying the premium is straightforward. It will be automatically deducted from your benefit payment if you receive benefits from any of the following:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
- Medicare Part B Deductibles
Like many insurance plans, Medicare Part B features a standard deductible. In 2023, this deductible amounts to $226. After meeting this deductible for the year, you’ll typically be responsible for 20% of the Medicare-approved amount for most Part B covered services.
Medicare Part B Coinsurance
Following the deductible, you’ll be subject to a 20% coinsurance that applies to:
Most physician services (including those received while hospitalized)
- Outpatient therapy
- Durable Medical Equipment (DME)
- Doctor’s visits for diagnosing mental health conditions
Concerned about Medicare expenses?
Every state offers Medicare Savings Programs for eligible beneficiaries with income below a certain level. Asset evaluation is also a factor in determining eligibility for most states. These state-sponsored programs can help cover your monthly Part A or Part B Medicare premiums. Importantly, they won’t alter your health plan benefits or coverage. These programs are provided by your state without any cost to you.
Am I eligible for Medicare Part B?
The majority of individuals become eligible for Medicare upon reaching the age of 65. Some may qualify earlier due to illness or disability. If you’re ready to explore your Medicare options, you can easily verify your eligibility on the Medicare.gov website.
When can I enroll in Medicare Part B?
Planning to enroll around your 65th birthday? Great news! You have a window of opportunity.
Your Initial Enrollment Period begins three months before your 65th birthday, includes your birthday month, and extends for three months after your 65th birthday month. This grants you a seven-month span to delve into Medicare details, compare plans, and make the optimal decision for your needs.
Already a Medicare plan holder?
Remember, selecting a Medicare plan isn’t a lifelong commitment. Generally, you can join, switch, or terminate an Original Medicare or Medicare Advantage (Part C) plan during the following periods:
- Open Enrollment Period: From October 15th to December 7th each year, you can join, switch, or drop a plan. Coverage begins on January 1st, provided the plan receives your request by December 7th.
- Medicare Advantage Open Enrollment Period: From January 1st to March 31st each year, if you’re enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or revert to Original Medicare.
- Special Enrollment Period: You can make changes to your Medicare Advantage and Medicare prescription drug coverage under specific life circumstances, such as moving or losing other insurance coverage.
Avoiding a Medicare Part B late enrollment penalty is crucial. Failing to enroll in Medicare Part B promptly, without credible coverage, could result in a late enrollment penalty of up to 10% increase in your premium for each 12-month period you were eligible but didn’t enroll.
You can postpone enrolling in Medicare Part B without penalty if you’re employed and covered by your employer’s private health insurance. Following the end of your employment health coverage, you have an 8-month window to sign up for Part B without incurring a late penalty.
Learn more about Medicare Enrollment Periods here.
Are there alternatives to Medicare Part B?
You have the option to choose a Medicare Advantage (Medicare Part C) plan. These plans are legally mandated to provide all the benefits of Original Medicare Part A and Part B. Additionally, many plans may include coverage for prescription drugs, dental, vision, and hearing services.
Need help? Call Brady Insurance Marketing: 801-347-2087. Our assistance is at no cost to you