For those looking to enroll in your standard Original Medicare plan, you have to familiarize yourself with all of the different kinds of coverage’s and policies offered that cover the multiple aspects of the Medicare program. Medicare is an elaborate health coverage plan offered as a federal program and is administered by the Centers for Medicare and Medicaid Services (CMS). We spoke about Medicare Part A in the last blog and will break down Medicare Part B in this piece. Medicare Part B is a medical health insurance coverage offered to Medicare-eligible recipients. Part B is the coverage used for medical coverage when going to the doctor or when a medical situation requires medical supplies such as a wheelchair or crutches. For more information on Medicare Part B, how it works, your potential share of the costs, what it covers, and when and how to enroll, read on!
What does Medicare Part B Cover?
Medicare Part B helps people cover medically necessary services and supplies needed for the diagnosis and treatment of your health conditions. This includes outpatient services that you might receive at a hospital, clinic, doctor’s office, or other health facilities. Medicare Part B will also help cover many preventive services to prevent illness or detect them at an earlier stage. Having both Medicare Parts A and B makeup “Original Medicare.”
What Benefits do I Receive from Medicare Part B?
Medical services and supplies covered by Part B include, but are not limited to, the following:
- Doctor visits
- Laboratory tests and X-rays
- Emergency ambulance services
- Durable medical equipment/supplies
- Mental health services
- Rehabilitative services, like physical and occupational therapy, and speech-language pathology services
Insurance Costs for Medicare Part B
For Medicare Part B, you will pay both a monthly premium and a yearly deductible. The monthly premium amount might vary depending on your own specific situation and changes year to year. This year, most people pay a monthly premium of $144.60 for Part B. These premiums are then deducted from your monthly Social Security check if you are receiving a monthly benefit. If not, you may have to pay directly to Medicare. Medicare bills quarterly, and will send you a quarterly bill.
Government subsidies you might be entitled to through your state can cover your Medicare Part B premium’s cost. If you are entitled to a state program that will pay your monthly premium, such as Full Medicaid, Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB), Qualified Individual (QI), or another program, the program will pay Medicare directly.
If your yearly income is above a specified amount updated annually by CMS, you might be required to pay a higher premium. The income used to set the adjusted amount is the income reported on your tax return from two years prior. This adjustment is referred to as the Income Related Monthly Adjustment (IIRMA).
Keep in mind that if you did not enroll in Medicare Part B when you first became eligible, you might have to pay the late-enrollment penalty in the form of a higher premium.
Out-of-Pocket Cost-Share Responsibilities When Using Medicare Part B
In addition to your monthly premium, you’ll also pay a yearly Part B deductible. This year the annual deductible amount for Medicare Part B is $198. This is a one-time cost paid as a first dollar amount by the Medicare beneficiary before Medicare begins to pay its share.
For individual specific services and supplies, your Medicare Part B costs might vary. In addition, some preventive services are entirely covered by Medicare Part B, if your provider accepts Medicare assignments. If the Medicare Part B deductible applies to the covered service, you have to pay all your care costs until you meet that yearly deductible amount before Medicare starts paying its share.
Medicare Part B has a co-insurance amount of 20 percent of the costs of any covered medical service rendered. This means that you’re responsible for paying 20 percent of all covered Medicare Part B services when you have Medicare Part B coverage. This 20 percent is in addition to your annual deductible. Keep in mind that there are no limits to your out-of-pocket cost-sharing responsibility with Original Medicare. Your share of the bill will grow as high as the services rendered costs with no limit.
How To Enroll in Medicare Part B
Generally, a person is entitled to Medicare on the first day of their 65th birth month. Being entitled does not automatically enroll an individual. You will be automatically registered if you are already receiving your Social Security benefits. If not, you will need to enroll via Social Security at https://www.ssa.gov/benefits/medicare/ or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You also can visit a local Social Security office that you can find using this link Office Locator.
A Medicare-eligible beneficiary can apply for Medicare three months before their eligibility, the month of eligibility, and three months after. This is known as the seven month Initial Enrollment Period.
Aside from eligibility when you turn 65, a person may also be eligible for Medicare because of a specific disability specified by the Social Security Administration. Most Social Security disability recipients are eligible for Medicare after 24 months of being eligible for Social Security Disability benefits. Still, there are a few exceptions that do begin the benefits sooner. These situations are unique and can occur if a person has End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
A person is required to enroll in Medicare Part B when they first become eligible for coverage. Not enrolling in Part B can become an issue later if you desire to enter later on. Keep in mind that if a person is still working, and has coverage through their employer group health plan, it is always a good idea to sign up for premium-free Medicare Part A when first becoming eligible. In regards to Medicare Part B, if you are still working, you will have to determine if your group health plan requires you to enroll in Part B. If not, you may even want to consider enrolling if the coverage you currently have is not as rich in benefits. You should make a comparison to see what best suits your lifestyle and healthcare needs. If your current employer does not require enrollment in Medicare Part B, you will have a short window to enroll in Part B and not be assessed a penalty when you choose to retire and lose group health coverage.
Not enrolling in Part B timely can bring issues later when you do want to enroll. There is a General Election Period to enroll in Medicare Part B each year from January 1st- March 31st. If you enroll in this period, your coverage will begin on July 1st of the year you enroll. But if you are enrolling in the General Enrollment Period, it probably means that you missed the Initial Enrollment Period, which can create a penalty to be added to the Part B monthly premium.
For more information on Medicare Part B, and how it can help you specifically, give Healthcare American a call today!
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