Medicare Part B

As you approach age 65, you may be wondering what to do about Medicare coverage. You can't even watch television without hearing about the various parts of Medicare. If you are wondering about what each part means you are in the right place. This page will discuss Medicare Part B, so you can confidently navigate enrollment and premiums associated with this specific part of Medicare coverage. Part B refers to Medical Insurance services, specifically medically-necessary and some preventative services. This coverage pertains to doctor visits, outpatient services, home health services, and medical equipment. Hospital and inpatient care is covered separately under Medicare Part A coverage.

Medicare Part B Coverage

When considering what Part B covers, you should think about outpatient or doctor's office type services. There are two main categories of covered items in Part B insurance.

  • Medically Necessary Services
    These are visits, services, and equipped deemed standard medical practice that are necessary to treat your medical condition. You must be formally diagnosed with the condition, and the services or equipment should be ordered by your doctor. Part B coverage also includes physical and occupational therapy services.
  • Preventative Services
    The preventative services covered under Medicare Part B include things like flu vaccinations, check-ups, etc. The goal with Medicare covered preventative treatment is to either detect a condition as early as possible so treatment is less involved and more successful or to prevent it completely, such as in the case of immunizations.

To check if specific treatments are covered, you can enter your Medicare Identification Number at the www.Medicare.gov website for more detailed coverage information. Prescription drug coverage can be added as Medicare Part D coverage.

Medicare Part B Costs

The medical insurance termed Part B coverage basically offers residents over 65 set medical coverage for a cheaper premium level than they would get at open market. The government pays about three-fourths of the premium cost, while individuals are responsible for a quarter of the cost. In 2012, the monthly premium responsibility for most enrolled Part B members is $99.90 per month. This rate applies to over 95% of people enrolled in Medicare, those individuals with a Modified Adjusted Gross Income (MAGI) level of $85,000 or less and married couples with a MAGI of $170,000 or less.

However, people who have higher income level (less than 5% of those enrolled) pay a higher percentage (than 25%) of the premium per month. The premium amount for those members will be determined by their reported earnings to the IRS. In addition, those with higher income levels will pay an added amount for prescription drug coverage as well.

If you were required to pay a higher than average premium but your income levels have gone down for some reason, such as divorce, loss of income property, or a job loss, you can contact Medicare with documentation proving the loss. They will refigure your monthly premiums according to your new income level.

There is also a late enrollment penalty. This means that if you wait to sign up for Medicare Part B coverage, rather than signing up when you first become eligible, you will pay a higher premium amount. The higher premium adds ten percent to the premium for each full year (12 months) that has passed between the time when you became eligible for Medicare coverage and when you actually enrolled.

Medicare Part B Enrollment

Most people become eligible for Medicare Part B coverage when they start receiving Social Security (or Railroad Retirement Board) benefits at age 65. This is also when you become eligible for Medicare Part A. You will be sent a Medicare card in the mail prior to the eligibility date.

Because you pay a premium for Part B coverage, enrollment is optional, so if you automatically receive a membership card and you do not wish to be enrolled in Part B, you will need to contact Medicare and let them know you do not wish to be enrolled.

If you are not receiving Social Security or Railroad Retirement Board benefits (such as if you are still working when you turn 65), you will need to enroll in Medicare Part B. The initial enrollment period is a seven month period that straddles your 65th birthday. This means that you can enroll during the month of your birthday, as well as the three months before and the three months after your birthday month. It is best to sign up early in the initial enrollment period to avoid delays in coverage. If you have missed your initial enrollment period, you can enrollment in the general enrollment period (January 1- March 31, each year). However, you may have to pay the late enrollment penalty.

Some people are eligible for a special enrollment period, because they were covered under a group health plan through their current employer during their initial enrollment period. This special enrollment period lasts for eight months and begins the month after the group health coverage or the employment ends.

If you are receiving Social Security or Railroad Retirement Board benefits due to a disability, you will get Medicare Part B coverage automatically. The coverage begins during the 25th month after the benefits began. There are special considerations for those people with Amyotrophic Lateral Sclerosis (ALS) and End-Stage Renal Disease (ESRD).