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.

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

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. Missing the Initial Enrollment Period means you need to wait until the Medicare General Enrollment Period to enroll in Part B.

Delaying enrollment can result in penalties.

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.

Medicare Part B – Eligibility

You’re eligible for Part B once you turn 65 years old. You must also be a citizen of the United States or a permanent resident for at least five consecutive years.

You could be eligible for 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

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
• An annual wellness visit
• Welcome to Medicare visit
• Lab tests
• Tests such as X-rays, MRIs, CT Scans and EKGs
• Some health programs, such as smoking cessation, obesity counseling, and cardiac rehab
• Physical therapy, occupational therapy, and speech-language pathology services
• Diabetes screenings, diabetes education, and certain diabetes supplies
• 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
• Skilled nursing care and health aide services for the homebound on a part-time or intermittent basis

Part B covers most of your medical expenses, but it does not provide dental or vision benefits.

Additionally, it won’t cover custodial care; such as help with bathing, dressing or the cost of an assisted living facility.

Medicare Part B Costs in 2020

The cost of Part B includes a premium, deductible, and coinsurance.

Part B Premium

Part B premium is $144.60 a month. If you receive Social Security, Railroad Retirement Board, or Office of Personnel Management benefit payments, your Part B premium will be deducted from your monthly check.

If you don’t receive Social Security, you could receive a monthly bill from Medicare. They have online payment options for those with a MyMedicare account.

If you do not receive any of the above benefits, you will receive a bill.

Part B Deductible

Part B has a small annual deductible; for 2020, the deductible is $198.

Also in 2020, the income brackets will increase. Most people pay the standard premium amount. However, if your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount. You can find how to appeal IRMAA here.

Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. This is the most recent tax return information provided to Social Security by the IRS.

The high-income bracket will increase from $85,000 to $87,000 for a single person. If you reported your income was above $87,000, your premium may be more.

Part B Coinsurance

After you have met your Part B deductible, Medicare pays 80% of the Medicare-approved cost of your medical expenses. To get the remaining 20% 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.”

Medicare Part B Enrollment

You may have experienced automatic enrollment in both parts of Medicare.

If you weren’t automatically enrolled, 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.

In most cases, if you do not sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B. Your monthly premium will go up 10% for each full 12-month period you go without coverage.

If you don’t sign up for Part B during your Initial Enrollment Period, you could still enroll in Part B during the General Enrollment Period from January 1st to March 31st each year.

Usually, you don’t pay a penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.

If you have limited income, your state may help you pay for Part A and/or Part B.

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.

Medicare Part B does not usually cover prescription medications administered at home. However, any medications not covered under your Part B may be covered under Part D.

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 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.

How Long Does it Take to Get Part B After Applying

If you’re automatically enrolled in 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 $198 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.

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