Medicare Part B
Original Medicare is made up of two parts: Medicare Part A provides hospital insurance, while Medicare Part B offers medical insurance. Together, these two parts equal Original Medicare, the federally administered health-care program for seniors and certain disabled individuals.
Medicare Part B covers medically necessary services and supplies, including doctor visits, preventive care, and durable medical equipment.
What does Medicare Part B cover?
The following are some examples of what Medicare Part B covers:
- Ambulance services: transport and travel to and from certain locations
- Chiropractic care for spine manipulation to correct a subluxation (in medically necessary circumstances, when performed by a chiropractor or other qualified health-care provider)
- Diagnostic tests and lab work
- Doctors services, such as office visits
- Durable medical equipment (DME)
- Home health services
- Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist
- Outpatient mental health services, including partial hospitalization
- Preventive-care services, including screenings and vaccines
- “Welcome to Medicare” and yearly “Wellness” physical exams
If you’re enrolled in a Medicare Advantage plan, you’ll still be covered for the same Medicare Part A and Part B coverage you would have had under Original Medicare. Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, so you’ll have the same baseline level of benefits that you would have under the federal program. In addition, your Medicare Advantage plan may cover other benefits to keep you healthy, such as routine vision or dental, wellness programs, or prescriptions drugs.
How do I get Medicare Part B?
To be eligible for Medicare, you must be a United States citizen or legal permanent resident of at least five continuous years and 65 years or older. You can also be eligible for Medicare before 65 if you’ve been receiving disability benefits from Social Security or the Railroad Retirement Board for at least two years, or if you have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
Like other parts of Medicare, there are rules concerning when you’re eligible and when you can sign up for coverage. If you’re already receiving retirement benefits before you turn 65, you may be automatically enrolled in Medicare Part A and/or Part B the month that you turn 65. You’re also automatically enrolled in Medicare if you’ve been receiving Social Security or Railroad Retirement Board disability benefits for at least two years; you’ll be automatically enrolled in the 25th month of disability benefits. Those who qualify for Medicare because of end-stage renal disease must manually sign up for Part B.
You can also sign up for Medicare Part B during the following periods:
- Initial Enrollment Period (IEP): This is when you are first eligible to enroll in Medicare, either by turning 65 or through disability. If you qualify because of age, your Initial Enrollment Period starts three months before you turn 65 and lasts for seven months. If you qualify for Medicare because of disability, your Initial Enrollment Period starts three months before your 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts seven months.
- General Enrollment Period (GEP): If you missed your Initial Enrollment Period, you can also enroll in Medicare Part B during this period, which occurs from January 1 to March 31 annually. If you enroll in Medicare Part B during the General Enrollment Period, your coverage will go into effect on July 1 of the year that you signed up. If you didn’t enroll in Medicare Part B when you were first eligible, you may have to pay a late-enrollment penalty, and your Medicare Part B premium may be 10% higher for every 12-month period that you could have had Medicare Part B, but decided not to get it.
- Special Enrollment Period (SEP): You may opt to delay your Medicare Part B enrollment if you or your spouse are working and have group health coverage based on current employment. When you or your spouse retires and you lose your group health coverage, you will be given a Special Enrollment Period to enroll in Medicare Part B. The Special Enrollment Period is the eight-month period following the month when the employer coverage ends or you stop working (whichever happens first). You can enroll any time you and your spouse remain covered by the group health plan or during the Special Enrollment Period.
You can enroll in Medicare Part B through Social Security in the following ways:
- Online at SSA.gov. If you’re not yet ready to apply for retirement benefits, you can apply for Medicare only.
- In-person at a local Social Security office.
- By calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. Social Security representatives are available Monday through Friday, from 7AM to 7PM.
If you worked at a railroad, you can apply for Medicare through the Railroad Retirement Board, not Social Security. Contact the Railroad Retirement Board to enroll at 1-877-772-5772 (TTY users, call 1-312-751-4701); Monday through Friday, from 9AM to 3:30PM.
Medicare Part B costs
While some people may be eligible for premium-free Medicare Part A if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes during that time, most beneficiaries must pay a monthly premium for Medicare Part B insurance unless they qualify for low-income assistance. This premium amount may change from year to year. Visit Medicare.gov to learn how much you may have to pay for your Medicare Part B premium.
If your income falls above a certain threshold, you may have to pay a higher amount for Medicare Part B coverage. This is known as an Income Related Monthly Adjustment Amount (IRMAA), which is an extra amount you’ll pay on top of your monthly Part B premium. Social Security will contact you if this applies to you.
In addition, you may owe certain out-of-pocket expenses for Medicare Part B-covered services, including copayments, coinsurance, and the Part B annual deductible. Once you’ve met your yearly deductible, you’ll usually pay 20% of the Medicare-approved amount for most medical services and supplies. However, this may vary, depending on the specific service or equipment. For the most up-to-date Medicare Part B cost information, visit Medicare.gov.
Do you have questions about what Medicare Part B covers? Or perhaps you’re interested in finding additional benefits beyond Original Medicare, such as through a Medicare Advantage plan. If you’d like to discuss your Medicare coverage options with a licensed insurance agent, call eHealth today to learn about Medicare plan options that may work for your situation.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.