Medicare Part B
Are you wondering about Medicare Part B eligibility, costs, enrollment, and deductibles? If you’re new to Medicare, questioning and worrying about coverage is normal.
Medicare Part B covers two types of services; medically necessary services, and preventive services.
Medically necessary services include services or supplies that are required to treat or diagnose a medical condition. Preventive Services include health care services to prevent an illness or to detect and treat an illness in the early stages.
What is Medicare Part B
Medicare Part B is the medical portion of Original Medicare. This includes benefits for medically necessary treatment for an injury, illness or health condition.
Part B will compliment your Part A coverage perfectly, they were designed to go together.
Medicare Part B is a part of Traditional Medicare. It’ll cover 80% of the Medicare-approved amount for certain medical services as well as treatments.
Discuss what it covers, the different out of pocket costs, when to enroll and how to apply.
Medicare Part B – Eligibility
If you’re eligible for Part A premium-free, then you can enroll in Part B by subscribing to Medicare services.
Even if you’re not eligible for premium-free Part A, you may qualify for Medicare Part B. This may apply to you if; you’re 65 or older, a United States citizen or, Permanent resident of at least 5 years.
You could be eligible for Medicare Part B if you’re under the age of 65; however, you would need to receive Social Security Disability Income for more than 24 months or have a qualifying illness.
What Does Medicare Part B Cover
Medicare Part B covers preventative services in addition to specialist services.
Part B medical insurance helps pay for:
- Doctor visits, including specialists, an annual physical and a second opinion before surgery
- Lab tests
- Tests such as X-rays, MRIs, CT Scans and EKGs
- Outpatient surgery
- Emergency room visits, including an ambulance if needed
- Some diagnostic tests, like mammograms and colonoscopies
- Medical equipment needed at home, like walkers and oxygen
- Mental health treatment
- Flu Shots
Additionally, it won’t cover custodial care; such as help with bathing, dressing or the cost of an assisted living facility.
How Much is Medicare Part B for 2019
The cost of Medicare Part B includes a premium, deductible, and coinsurance.
Medicare’s Part B premium is $135.50 a month. If you receive Social Security, your Medicare Part B premium will be deducted from your monthly check.
If you don’t receive SS, you could receive a monthly bill from Medicare. They have online payment options for those with a MyMedicare account.
Part B has a small annual deductible; for 2019, the deductible is only $185 for the entire year.
After you have met your Medicare Part B deductible, Medicare pays 80 percent of the Medicare-approved cost of your medical expenses. To get the remaining 20 percent covered, you would enroll in a Medicare Supplement plan.
In most states, the doctor can add an extra 15 percent to the Medicare rate – and you’re responsible for paying these “excess charges.”
Once your Part B Medicare insurance is effective, you’ll have 6 months to enroll in a supplement plan with Guaranteed Issue. After this time frame, you may be required to undergo a medical underwriting.
To compare rates in your area on the different types of Medicare plans, fill out the form.
You may have experienced automatic enrollment in both parts of Medicare.
If you weren’t automatically enrolled, Medicare Part B enrollment includes a seven-month Initial Enrollment Period. This period begins three months before the month you turn 65, the month of your birthday and ends three months after.
Do You Need Part B
Are you or your spouse still working at age 65? Does employer health insurance cover you? Then, you may not have to sign up for Part B right away.
When you qualify for a Medicare Special Enrollment Period for Part B you get to enroll, penalty-free, when your employer coverage ends.
You don’t qualify for a SEP? Or, you didn’t sign up when you turned 65?
You could still enroll in Part B during the General Enrollment Period from January 1st to March 31st each year.
However, you’ll probably pay a late enrollment penalty – a higher premium for the entire time you have Part B — and your coverage will not take effect until July 1st.
Does Medicare Part B Cover Prescriptions
Typically, Part B will cover prescriptions administered in a hospital or by a healthcare professional. For example, if you need chemotherapy, Part B could be the insurance you need.
Drugs Part B does Cover:
- Medications administered using durable medical equipment
- Certain types of antigens
- Injectable osteoporosis medications
- Oral End State Renal Disease medications
- Blood clotting factors
- Erythropoiesis-stimulating agents
How to Apply for Medicare Part B
You can apply for Medicare Part B online, in person, or over the phone with Social Security. Although if you worked for the Railroad Retirement Board, then you’ll need to call the RRB.
Those receiving Railroad Retirement benefits or benefits from Social Security are in most cases, automatically enrolled.
For more information on how to apply for Medicare Part B, click here.
How Long Does it Take to Get Medicare Part B After Applying
If you’re automatically enrolled into Part B, your coverage begins the first day of the month you turn 65. The only exception is if your birthday is on the first day of the month.
It can take up to 30-60 days to be approved if you’re applying outside your initial enrollment period and not automatically enrolled.
Am I Required to Pay the Part B Deductible Up Front
No, we always tell our clients to never pay the Part B deductible upfront. Your doctor will need to bill Medicare first. They will then bill you for the $185 deductible.
When you pay this upfront, Medicare has no record of it and you’re still expected to meet the deductible. Often times, doctors offices don’t understand how Medicare billing works and ask that you pay some sort of copay up front.
Medicare Resources for Beneficiaries
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