Medicare Part B – What is it and How Does it Work?

Medicare was created to help seniors deal with the high cost of health care as they age.

The program has expanded into several different parts over time. making it more comprehensive and more complicated to understand. Medicare Part B was the first of these expansions in coverage and is now a vital part in helping seniors keep their costs low.

What is Medicare Part B

While Part A was designed to help seniors with the high cost of hospital care, Medicare Part B is used for out-patient and well-patient expenses.

This means that whenever you are not admitted to a hospital, Part B is there to cover some or all of the expenses involved in those medical services and procedures. Since these services vary greatly, the coverage you get has to be broken down into smaller pieces.

Coverage with Medicare Part B

Medicare Part B covers two main service types: preventive care and outpatient medical care (Medicare Part A offers hospital coverage).

Preventive care

Preventive care includes services necessary to prevent you from becoming ill. These services may include things such as:

• Vaccinations such as the flu shot
• Screenings for specific conditions such as cancer, diabetes, or heart disease
• Mental health screenings
• Bone density testing
• Nutrition counseling
• Services to cease tobacco use
• An annual wellness exam

While not all preventive services are covered (such as dental cleanings), the list above is also not all inclusive—it covers a lot.

Outpatient Medical Care

These services include things that are medically necessary—this point is key—to diagnose or treat you outside of a hospital or hospice setting. Some examples include:

• Ambulance services
• Clinical research studies
• Mental health treatments
• Durable medical equipment
• Office visits
• Diagnostic testing
• Limited prescriptions (Medicare Part D covers most of these)

Again, this list is not exhaustive. In most cases, the easiest way to find out if a service you may need is covered is to ask your care provider’s billing department.

What’s Not Covered

There are a few items which are explicitly not covered by Medicare Part B, including:

• Almost all dental care including dentures
• Eye exams
• Hearing exams and aids
• Long-term care
• Routine foot care such as that needed by diabetics
• Any medical procedure deemed not medically necessary (such as cosmetic services)

Supplementary insurance plans may cover all the above. Also known as Medigap policies, these are offered by private insurance companies and not the government.

Eligibility

To be eligible, you have to enroll and pay a premium. You’re also eligible for Medicare Part B if you already have Medicare Part A.  Don’t worry if you don’t qualify Part A (as a pre-condition), you can still qualify by being:

• 65 years old or more
• A U.S. citizen
• Permanent resident for at least five years

If you’re under 65 years and receive social security benefits because of a disability, you also qualify for enrollment after 24 months. You may also be considered for Part B if you’re under 65 years and have an end-stage renal disease or Lou Gehrig’s disease (ALS).

Enrollment

If you’re 65-years old and receiving Social Security income benefits, you need not enroll as the SSO will take care of the enrollment. The same applies to a disabled person who is under Medicare A. In both cases, you will receive your cards within a month or two or just before you turn 65. If you intend to use your coverage at a certain time, make sure you apply in advance.

The moment you turn 65-years old and have Medicare Part B, the 6-month Medigap Open Enrollment Period starts. It’s also the appropriate time to get Medicare Supplement insurance. Since the enrollment is open and includes a guaranteed-issue right, you are at liberty to get any Medigap plan without going through underwriting or paying higher premiums because of a pre-existing condition.

If you’re not enrolled automatically, you can apply for coverage through Social Security or by visiting the Social Security office near you or from its website. You can also contact live operators at 1-800-772-1213 between 7 am to 7 pm on weekdays. They will assist you in enrolling in Medicare Part B.

Premiums may change from one year to another, and the amount varies depending on prevailing conditions. Medicare B premiums are automatically deducted from your Social Security benefits. Different income levels have different premiums. If your monthly income surpasses a specific amount, your monthly premiums could go up.

Delaying Enrollment

Some individuals may not get Medicare Part A, which doesn’t come with premiums. So, they may postpone or delay getting Medicare Part B as it comes with a premium. The majority of the people who delay are covered by their employer group plan or their spouses.

If you’re employed, find out from your health benefits administrator how your insurance could affect Medicare coverage. There’s no reason to worry if you postpone the enrollment because of existing coverage, though. You still have a window of opportunity during the Special Enrollment Period, which doesn’t incur a late registration penalty.

Once your employer’s health coverage lapses or expires or you quit your job, you have eight months to sign up for Medicare B. Take note that COBRA and retiree coverage are not viewed as health coverage with regards to your current job status, so that would not make you eligible for the special enrollment period. If you have COBRA, don’t wait for it to expire. The eight-month special period starts the moment you part ways with your current employer.

The right time to enroll is during the Initial Enrollment Period.

Late Enrollment Penalty

Should you fail to enroll for Medicare B while you were initially eligible, you will be penalized for later enrollment. The penalty is about 10 percent for each year that lapses before you enroll. Effective 2019, the penalty that applies to Part B Premiums is $135.50.

When you finally enroll, you’ll have to wait for the Medicare General Enrollment Period to register for Part B. The window is between January 1st and March 31st every year. Benefits will start coming the following July. Delaying will not only set you back a few hundred dollars but cause you to wait for many months before your coverage becomes active.

Other Parts of Medicare

Part B is one several part of your available Medicare coverage. The other parts include:

Part A – The original coverage offered by Medicare, Part A helps with inpatient hospital expenses and hospice care.

Medicare supplement plans – Created to help fill the coverage gaps of Medicare, Megiap plans are very important for anyone on traditional Medicare coverage.

Part D –  Helps with the cost of prescription drugs.

Part C (Advantage Plans) – Created to replace Medicare coverage with a private health insurance, Medicare Advantage plans can be the best option for many people.

In Summary

Medicare Part B plays a vital role in supporting the healthcare needs of millions of Americans who are 65-years old and above, and like conventional health insurance plans, a person has to pay monthly premiums to get coverage.

The good thing is it covers doctor’s visits and many outpatient services, including preventive care. If you’re turning 65 and have Medicare A, you will be enrolled automatically, but if you have problems, visit the nearest Social Security office for assistance.