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What is Medicare Part B?

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Medicare Part B coverage is the second and last part of what is referred to as Original Medicare. The rules of eligibility for Part B are simpler than those of Part A.  If you are 65 and older, and a US citizen OR are a permanent resident who has been here lawfully for five consecutive years ...

You are eligible to enroll in Part B medical insurance. This is true whether or not you are eligible for Part A coverage.  There is a premium for Part B, and the standard premium amount is $121.80 (but the premium may be higher depending on your income).

If you are receiving Social Security, Railroad Retirement Board or Office of Personnel Management benefits, your Part B premium amount will automatically be deducted from your monthly benefits.  If you do not receive these benefits, you could still choose to have the premium deducted monthly from your SS check, directly billed quarterly or mail in the Easy Pay Form for auto drafts from your bank account. 2016 Part B deductible is $166.00, this may change at the beginning of the calendar year, January 1st, 2017.

After you meet your deductible you will pay 20% of the Medicare approved amount for most doctor services, including doctor services while you are in an inpatient hospital, for outpatient therapy, and for durable medical equipment.  

Part B medical insurance is intended to cover basic medical services that are provided by doctors, clinics and labs.  Taking the time to learn what is a covered service and what is not is very important because then you are able to get the most benefits by fitting your medical treatments into the covered categories whenever possible.  Part B medical insurance covers two types of services.

  • Medically Necessary Services: These are services or supplies that are needed to diagnose to treat your medical conditions that meet expected standards of medical practice.  
  • Preventative Services: This is healthcare that is used to prevent illness (such as the flu or pneumonia) or to detect it at an early stage when treatment is most likely to work the best.  

Part B Insurance Pays For:

  • Doctor Services: provided at a hospital, doctors office or your home.  (Including surgery)
  • Laboratory Tests and XRays
  • Emergency Ambulance Services
  • Mental Health Services
  • Durable Medical Equipment: Such as casts, splints, prosthetic devices, wheelchairs, hospital beds, pacemakers etc.  
  • Preventative Services: such as flu shots, mammograms, bone density tests and screenings- such as those for cancer, glaucoma, diabetes, osteoporosis, heart disease etc.  
  • Rehabilitative Services: this includes physical therapy, occupational therapy, and speech language pathology services.
  • Part- Time Skilled Nursing Care, Speech Therapy and Physical Therapy Provided in The Home
  • One Time Wellness Exam: This needs to be performed within 6 months of when you enroll into Medicare Part B

In most cases if you do not enroll in Part B when you first become eligible you will have to pay a late enrollment penalty for as long as you have Part B coverage. If you receive a penalty for late enrollment your monthly premium will increase up 10% for each full 12 month period that you could have had Part B but did not sign up.  You also may need to wait until the General Enrollment Period, which runs from January 1st to March 31st, to enroll in Part B, and your coverage will not start until July 1st of that year.  There are instances in which you may not have to pay a late penalty if you meet certain conditions that would allow you to sign up for Part B during a Special Enrollment Period (SEP). 

 

If you have any questions about Medicare Part B, feel free to give our

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