What is Medicare Part B?
Medicare Part B is medical insurance that pays for health care services you receive as an outpatient. It also covers physician services both in and out of the hospital. Medicare Part B and Part A make up what is called Original Medicare.
What Does Medicare Part B Cover?
Medicare Part B medical insurance covers two categories of healthcare costs:
- Medically necessary: supplies and services required to treat a health condition.
- Preventive: services that prevent a health condition from developing or catch it while in its infancy.
Medicare Part B medically necessary services are subject to deductibles and coinsurance and include the following:
- Doctor visits
- Physical therapy (if requested by a doctor)
- Clinical laboratory services (blood and urine samples, for example)
- Ambulatory surgery center
- Diagnostic tests such as MRIs, CT scans, EKGs, and X-rays
- Durable medical equipment used at home (wheelchairs or walkers)
- Emergency room services
- Physician services while in the hospital
- Outpatient mental health care
- Periodic skilled nursing care for the homebound
- Ambulance services
- Cardiac rehab
- Certain oral and vision surgeries
Medicare Part B covers the following preventive care:
- Hepatitis B, flu, and pneumococcal shots
- Diabetes, cancer, and cardiovascular screenings
- Glaucoma tests
- Bone density measurements
- Alcohol misuse and depression screenings
What is Not Covered?
It is important to remember that Medicare Part B does not cover all of your healthcare costs.
Medicare Part B does not cover:
- Outpatient prescription drugs
- Hearing exams or hearing aids
- Eyeglasses or routine vision exams
- Routine dental services, including dentures
- Routine foot care
- Long-term care
- Cosmetic procedures
- Medicare Part B excess charges
Part B Excess Charges
Medicare Part B excess charges might apply if a nonparticipating provider delivers your care. Under federal law, doctors who sign up with Medicare (accept assignment) cannot charge more than Medicare’s approved amount for a service. However, doctors who do not participate in Medicare can charge up to 15% more than the agreed rate. Medicare Part B does not cover this 15% excess charge, but enrolling in a Medicare Supplement Plan (Plan F or G) will cover it.
Who Qualifies for Medicare Part B?
If you qualify for premium-free Part A, you are eligible for Medicare Part B once you qualify for Part A.
If you pay a premium for Part A coverage, you must meet the following requirements to be eligible for Medicare Part B:
- Be 65 or older
- Be a U.S. resident
- Be either a U.S. citizen or a lawfully abiding U.S. resident for at least five continuous years
You are also eligible for Medicare Part B if you are under 65 and meet one of the following conditions:
- You are receiving disability benefits through SS or Railroad Retirement
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral disease (ALS or Lou Gehrig’s disease)
When Should I Enroll?
If you receive SS or Railroad Retirement benefits, you are automatically enrolled in Medicare Part B medical insurance.
If you are not automatically enrolled in Medicare Part B and have to sign up, your Initial Enrollment Period (IEP) is the best time to do so. Your seven-month IEP starts three months before your 65th birthday, includes your birthday month, and ends three months after you turn 65.
You can opt not to enroll in Medicare Part B when you are first eligible. However, if you wait to join after your IEP, you might face a penalty.
If you delay enrollment, you have two other times when you can enroll in Medicare Part B:
- General Enrollment Period (GEP). If you opt-out of Medicare Part B automatic enrollment or do not enroll during your IEP, you can join during the GEP. General enrollment runs from Jan. 1 through Mar. 31 of each year. You will pay a penalty for late enrollment; the penalty will be added to your Medicare Part B premium.
- Special Enrollment Period (SEP). Individuals who do not sign up for Medicare Part B during their IEP because they had coverage under a group plan through their employer (or spouse’s employer) can enroll during a SEP. The SEP is an eight-month period that starts when your employment (or your spouse’s) ends or your group coverage ends, whichever comes first. You will not be charged a late penalty if you sign up for Medicare Part B during a special enrollment period.
How Do I Enroll?
You can sign up during one of the enrollment periods by contacting the Social Security Administration in one of several ways:
- Over the phone (1-800-772-1213)
- At your local Social Security office
How Much Does it Cost?
You must pay a monthly premium for your Medicare Part B medical insurance. The federal government sets the Medicare Part B premiums and will automatically deduct the premium from your benefits check if you receive help from one of the following:
- Social Security
- Railroad Retirement
- Office of Personnel Management
If you do not receive any of these benefit checks, you will receive a quarterly bill. You can pay your Medicare Part B bill with a check or credit card. You can also pay your Medicare Part B premium through Medicare Easy Pay, a service that deducts your monthly premium from a savings or checking account.
Your premium amount is based on income. Most seniors pay the base rate. However, if your modified adjusted gross income (MAGI) is above a certain threshold, you will pay more for your Medicare Part B premiums.
Following are several examples breakdown of income ranges and their monthly premiums for 2023:
Premium Amount: $164.90
- Less than or equal to $97,000
- Less than or equal to $194,000
Premium Amount: $230.80
- Greater than $97,000 and less than or equal to $123,000
- Greater than $194,000 and less than or equal to $246,000
Premium Amount: $164.80 - $329.70
- Greater than $123,000 and less than or equal to $153,000
- Greater than $246,000 and less than or equal to $306,000
Premium Amount: $263.70 - $428.60
- Greater than $153,000 and less than or equal to $183,000
- Greater than $306,000 and less than or equal to $366,000
Premium Amount: $362.60 - $527.50
- Greater than $183,000 and less than $500,000
- Greater than $366,000 and less than $750,000
Premium Amount: $395.60 - $560.50
- Greater than or equal to $500,000
- Greater than or equal to $750,000
The premiums continue with this pattern the higher an individuals MAGI is.
Are There Coverage Gaps?
Medicare Part B pays 80% of its approved rate for medically necessary services, not 100%. The remaining 20%, called Medicare Part B coinsurance, is your responsibility to pay.
You also have an annual Medicare Part B deductible that you must pay before Medicare Part B pays anything on your claims. In 2023, the Medicare Part B deductible was $226.
Unlike Part A, your Medicare Part B deductible is tied to a calendar year, not a benefit period. Therefore, your deductible starts over each year on Jan. 1.
The coverage gaps between the Medicare Part B payment and your Medicare Part B deductible and Medicare Part B coinsurance responsibility can add up quickly if you have a chronic health condition. Medicare Supplement Plans (Medigap plans) can help cover these expenses.
What Part B Covers
Part B Excess Charges
Part B Eligibility
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