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Medicare Part B: What Does Medicare Part B Cover?


who is eligible for medicare part aMedicare Part B 

Original Medicare Part B (medical insurance) provides medical services and supplies that are medically essential to treat your health condition. Outpatient treatment, preventive services, ambulance services, and durable medical equipment are all examples of this. If a doctor orders them to treat your disease, it also covers part-time or intermittent home health and rehabilitative treatments, such as physical therapy.

A one-time “Welcome to Medicare” preventative visit,* flu and hepatitis B injections, cardiovascular screenings, cancer screenings, diabetes screenings, and more are among the preventive services covered by Medicare Part B. Refer to the Medicare guidebook, “Medicare and You,” for a complete list of preventative services covered under Medicare Part B.

*Please note that the “Welcome to Medicare” appointment is only covered by Medicare Part B for the first 12 months.

If you have a Medicare Advantage plan, a private health insurance company contracted with Medicare will cover both your Medicare Part A and Part B coverage. Medicare Advantage plans are required by law to provide at least the same level of coverage as Original Medicare, and some plans provide extra benefits not available through Original Medicare, such as basic dental and/or eye care, hearing aids, and even prescription drug coverage.

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hospital insuranceAm I eligible for Medicare Part B?

By enrolling and paying a monthly premium, everyone who is qualified for premium-free Medicare Part A becomes eligible for Medicare Part B. If you don’t qualify for premium-free Medicare Part A, you may be eligible for Medicare Part B if you meet the following criteria:

  • You must be at least 65 years old.
  • You must be a United States citizen or a lawful permanent resident who has lived in the United States for at least five years.
  • You may also be eligible for automatic enrollment in Medicare Part B if you are disabled. After 24 months of disability benefits, if you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits, you will be automatically enrolled in Medicare Part A and Part B. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s illness), you may be able to enroll in Medicare Part B before turning 65.

hospital insuranceHow much does Medicare Part B cost?

Part B of Medicare entails certain out-of-pocket expenses on your part. There may be deductibles, coinsurance, and/or copayments, as well as a monthly cost. Let’s take each of these in turn.

The amount of your Medicare Part B monthly premium may change from year to year, depending on your circumstances. The premium is withdrawn automatically from many people’s Social Security checks.

In 2022, the normal monthly Part B premium will be $170.10.

Because there are different premiums for different income levels, if your income surpasses a specific amount, your premium may be greater than the regular premium.

Your Part B contribution will be withdrawn directly from your monthly benefit if you receive Social Security, Railroad Retirement Board, or federal retirement benefits. If you don’t, a bill will be mailed to you every three months.

In 2022, the monthly premium for Medicare Part B will be $0. You are the one who pays. If your annual income is $20,000, If you submitted a tax return as an individual, $170.10 if you submitted a combined tax return {{IRMAA INDIV LINE 1}} or fewer {{IRMAA MARRIED JOINT LINE 1}} {{IRMAA PARTB PREMIUM LINE 2}} {{IRMAA INDIV LINE 2}} {{IRMAA MARRIED JOINT LINE 2}} {{IRMAA PARTB PREMIUM LINE 3}} {{IRMAA INDIV LINE 3}} {{IRMAA MARRIED JOINT LINE 3}} {{IRMAA PARTB PREMIUM LINE 4}} {{IRMAA INDIV LINE 4}} {{IRMAA MARRIED JOINT LINE 4}} {{IRMAA PARTB PREMIUM LINE 5}} {{IRMAA INDIV LINE 5}} {{IRMAA MARRIED SEP LINE 5}} {{IRMAA PARTB PREMIUM LINE 6}} IRMAA INDIV LINE 6 or more IRMAA INDIV LINE 6 or more IRMAA INDIV LINE 6 More than $409,000 You are the one who pays. If you’re married but file a separate tax return from your spouse and make $170.10 per year, less than IRMAA INDIV LINE 1 {{IRMAA PARTB PREMIUM LINE 5}} {{IRMAA MARRIED JOINT LINE 5}} {{IRMAA PARTB PREMIUM LINE 6}} or more IRMAA MARRIED JOINT LINE 6

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Medicare Part B deductible in 2022

In 2022, the annual deductible for Medicare Part B will be $233. In most cases, you’ll have to pay this deductible before Medicare begins to pay its share of covered services. The deductible does not apply to all services provided under Part B.

Medicare Part B and coinsurance/copayments

For covered services, you normally pay a 20% coinsurance fee. You would pay the Part B deductible plus 20% of the Medicare-approved price for services performed if your doctor or health care provider accepts assignment for covered treatment. Accepting the assignment means that your doctor will not charge you more for the covered service than the Medicare-approved price. You’d still be in charge of cost-sharing.

When can I enroll in Medicare Part B?

If you start receiving retirement benefits before turning 65 or if you qualify for Medicare due to a disability, you’ll be automatically enrolled in Parts A and B of Medicare as soon as you’re eligible.

If you missed your original registration time and do not qualify for a special enrollment period, you can enroll during the yearly General Enrollment Period, which runs from January 1 to March 31, with coverage beginning July 1. If you didn’t sign up when you were originally eligible, you may have to pay a late enrollment penalty.

If you aren’t automatically enrolled in Medicare, you can apply in person at a local Social Security office, online at the Social Security website, or by calling 1-800-772-1213 (TTY users 1-800-325-0778) from 8 a.m. to 7 p.m., Monday through Friday, in all U.S. time zones.

Keep in mind that your six-month Medigap Open Enrollment Period begins after you are both 65 years old and have Medicare Part B. Because you have a “guaranteed-issue right” to buy any Medigap plan without medical underwriting or incurring a higher premium due to a pre-existing condition** during the open enrollment, this is the optimum time to acquire a Medicare Supplement insurance plan. Once you’ve enrolled in Medicare Part B, make sure you don’t miss the one-time guaranteed-issue Medigap enrollment period.

group health plan coverageCan I delay enrolling in Medicare Part B?

Some people may be eligible for “premium-free” Medicare Part A, but the majority of people must pay a monthly premium for Medicare Part B. If they are currently insured under an employer group plan (either their own or through their spouse’s employer), some persons may choose not to sign up during their initial enrollment period because Medicare Part B has a monthly premium.

If you’re still employed, check with your health benefits administrator to see how your insurance will interact with Medicare. If you put off enrolling in Medicare Part B because you already have health insurance via your work, you can do it during a Special Enrollment Period and avoid paying a late fee. If you are still covered by a group plan via your current employer, you can enroll in Medicare Part B at any time. You have an eight-month special enrollment period after your employer’s health coverage finishes or your work ends (whichever comes first) to sign up for Part B without paying a late penalty.

Remember that retiree coverage and COBRA are not considered health care based on current employment, and you would not be eligible for a special enrollment period if you had them. If you have COBRA coverage after your employer’s coverage ends, you should sign up for Medicare Part B as soon as possible. Your eight-month special enrollment period for Part B begins the day after your current job or group plan finishes (whichever comes first). This is true whether or not you are covered by COBRA.

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*Pre-existing conditions are medical issues that existed before the start of insurance coverage. They may limit coverage, exclude you from coverage, or even prohibit you from being approved for a policy; however, each plan’s exact definition and applicable limitations or exclusions of coverage will vary, so read the official plan documentation to see how that plan handles pre-existing conditions.

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