Millions of retirees and Social Security recipients rely on Medicare coverage for their health care. Medicare is divided into several different parts, and it can be pretty confusing. There is Medicare Part A, Medicare Part B, Medicare Advantage Plans (formerly Medicare Part C), and Medicare Part D, or prescription drug plans. Each part provides different coverage and also has different premiums, deductibles, and copays. So, what exactly is Medicare Part B? This part of Medicare is similar to traditional health insurance in that it pays for traditional doctor visits and outpatient services. There are many nuances to this coverage, so keep reading as we give you all the details.
What Is Medicare Part B?
Original Medicare is broken into two parts — Medicare Part A and Medicare Part B. Medicare Part B is considered health insurance, while Medicare Part A is considered hospital insurance. Part B covers things like doctor visits and preventive services. Part B Medicare has been around since the program’s inception in 1965.
The Federal government saw the need for Medicare because of the number of people receiving Social Security benefits. Most health insurance plans were employer-sponsored plans. When these retirees left the workforce, they were left with no good options for medical insurance. Hence, Medicare was started. At that time, only Parts A and B existed. Medicare Advantage plans and prescription drug coverage came at a later date.
Medicare should not be confused with Medicaid. Medicaid is mostly a state-funded plan that exists to help people who cannot afford insurance. Medicare, on the other hand, is a Federal program that provides benefits to people over age 65 and younger individuals with disabilities.
What Medicare Part B Covers
Many people wonder what does Medicare cover, and they specifically wonder what does Medicare Part B cover? Medicare B covers a wide array of items and services. Specific coverage can vary between plans if you are enrolled in a Medicare Advantage Plan. However, each plan must offer at least the same coverage provided by Original Medicare. If your insurance company chooses to offer additional coverage, that is allowed.
Since Part B is considered normal medical insurance, it covers things like doctor services, outpatient care, wellness visits, home health care, and durable medical equipment. The services covered by Part B are broken into two large categories. These are medically necessary services and preventive services. The specifics of each of those categories entail many different things.
Though you might not think of these items based on the two categories above, Part B also covers mental health treatments (even inpatient treatment), ambulance services, clinical research, durable medical equipment (like wheelchairs), and some outpatient prescription drugs. When it comes to preventive services, this can cover things like flu vaccines, screenings for certain conditions, like cancer, or lab tests. Although Part A is considered hospital insurance, your Part B coverage will cover certain things during your hospital stays like diagnostic imaging, chemotherapy, or dialysis.
It is always a good idea to determine whether an item or service will be covered prior to receiving the service. You can talk to your health care provider about the service, and you can also check coverage details at Medicare.gov. You can find what Medicare Part B covers there and even check specific items. If you have a Medicare Advantage Plan, then you should check with your private insurance company for coverage details.
Services Not Covered By Medicare Part B
Although the list of services covered by Part B is quite extensive, there are also many things that Part B does not cover. Many of the items not covered by Part B are covered by other parts of Medicare, although some services are not covered at all by Medicare. As a general rule, Part B does not cover any service that is not considered medically necessary. Part B also does not cover any inpatient care or hospital stays. Likewise, short-term or long-term care in a skilled nursing facility is not one of the covered services included with Part B. These health services are covered by Medicare Part A.
Prescription drugs are not covered by your Part B health plan. However, if you are enrolled in a Medicare Part D plan, then you get coverage for those prescription drugs. Medicare never includes dental or vision benefits, and it also does not pay for care in a nursing home. However, some Advantage plans include both dental and vision coverage. Since these plans are administered by private insurance companies, they can set their own coverage rules as long as they meet the minimum Medicare requirements.
Since there are a number of items not covered by Medicare, many people choose to purchase supplemental insurance to go along with their Medicare coverage. This is also called Medigap coverage. These Medicare supplement policies help with out-of-pocket expenses for items not covered by Medicare. In addition, they can also help with the cost of coinsurance payments or deductibles.
Medicare Part B Costs For 2022
Now that you know what is covered by Part B and what is not, you might be wondering how much this coverage will cost you. The answer depends on a few different factors, like your income. Plus, there are different aspects to consider when looking at the total cost of the coverage. In addition to monthly premiums, there are also deductibles and copays to think about. Here is how much Part B will cost you in 2022.
— Part B Premiums
While some people qualify for premium-free Part A coverage, Part B always requires a premium. The standard premium for Part B coverage in 2022 is $170.10. As your income increases, this premium will also increase. The more money you make per year, the more you will have to pay for your monthly premium. Your premium amount will be based on your tax return from two years ago. In addition, you might be required to pay a late enrollment penalty if you do not enroll in Part B coverage when you become eligible. This could cost you higher premiums for the rest of your life. For each 12-month period you were eligible but not enrolled, you will pay a 10% penalty. If you receive Social Security benefits, Railroad Retirement Board benefits, or Office of Personnel Management benefits, then your premiums will be automatically deducted from your monthly check.
Just like with most insurance plans, your Medicare plan B comes with an annual deductible that must be met before your coverage starts to pay for services. For 2022, the deductible amount for Part B is $233. This amount is likely to increase each year, as are the premium amounts.
Part B does not typically have copayments, but there are coinsurance amounts that will be required. Copayments are set amounts that you pay when you receive a service. For instance, a doctor’s office visit might have a copay of $20. Coinsurance payments, on the other hand, are a percentage of the cost of the service. For Part B, this is usually 20% of the cost of the medical service. If you have an Advantage plan, you should check your plan documentation for your specific coinsurance amount.
Eligibility & Enrollment For Medicare Part B
So, who is eligible for Medicare Part B, and how do you enroll in Medicare? Here is what you need to know. There are a couple of different ways to become eligible for Medicare. First, you are eligible if you are age 65 or older. You are also eligible for Medicare Part B if you are under age 65 and have a disability for which you receive disability benefits through SSDI. Finally, if you have ALS or end-stage renal disease, then you are eligible for Part B benefits.
You might be wondering, “How do I apply for Medicare?” Well, you might be automatically enrolled in coverage. If you are age 65 or older and already receive Social Security retirement benefits, then you will get signed up for coverage automatically. Likewise, if you have received SSDI benefits for 24 months, then your enrollment is automatic. People with ALS will also be automatically enrolled in the program. If you qualify for benefits but are not automatically enrolled, then you will need to apply for Part B coverage. Applying for Medicare is simple and can be done quickly and easily online. Just be mindful of the timing of your application.
If you want to pay the lowest premium possible, you will need to sign up during your initial enrollment period. This period starts three months before your 65th birthday and runs for three months past your birthday. If you do not apply during this time, then you will need to wait for the open enrollment period. Not only will waiting until the general enrollment period delay your benefits, but it will also cost you an extra monthly adjustment amount of 10% on your premium for every 12-month period that you wait. The only exception to the late enrollment penalty is if you can qualify for a special enrollment period. This typically occurs when you are still working and are covered through a group plan with your employer. You will then be allowed to sign up when your group coverage ends, and you will also not have to pay the late penalty.
The Bottom Line
Medicare Part B provides medical insurance to retirees and younger people with disabilities. It covers things like doctor visits, lab tests, durable medical equipment, and mental health services. Part B does have a monthly premium in addition to cost-sharing methods like deductibles and coinsurance. In some cases, you may be enrolled automatically, but that is not always the case. If you are not enrolled automatically, make sure that you sign up during your initial enrollment period, or you may wind up paying more for your premium.
Frequently Asked Questions
What is the difference between Medicare Part A and Part B?
The main difference is in the items covered by each. Part A is considered hospital insurance and covers inpatient care. Part B, however, covers outpatient services, doctor visits, and preventative services. Many people qualify for Part A with no premium; however, there is a premium associated with Part B coverage.
Is Medicare Part B required?
Some people wonder, “Do I have to apply for Medicare Part B?” No, it is not required. Since you have to pay a premium for this coverage, you may elect to decline the coverage if you wish. You might also choose to enroll in a Medicare Advantage plan that consolidates all your Medicare coverage into a single plan with a private insurance company.
Is Medicare Part B ever free?
No, Medicare Part B coverage is never free. However, some beneficiaries may be able to get financial assistance that will cover part or all of the premium. If you are dual-eligible for Medicare and Medicaid or a low-income beneficiary, you may be eligible for a Medicare Savings Plan. These plans can help cover the costs of your premiums as well as your deductibles and copays.
What are the benefits of Medicare Part B?
The benefits provided by Medicare Part B are health care coverage. You can receive many routine and preventative services at no cost or a low cost. Part B helps pay for doctor services, lab work, screenings, and many other medical services. It would be extremely expensive to pay for these items without this coverage.