This month, we continue our four part series on the four main parts of Medicare. Each section will focus on one alphabet part to help clear up the coverage, eligibility, cost, and enrollment for that particular Medicare letter.
Last week we focused on Medicare Part A, this week we’ll continue with taking a closer look at Medicare Part B.
What is Part B?
Medicare Part B covers two main areas:
- Services and supplies that are medically necessary
- Preventative services
Medically necessary services or supplies are those that are needed to diagnose or treat a medical condition. Preventive services are those provided by a health care professional to prevent illness or detect it at an early stage. Medicare Part B is voluntary, but most people sign up when they first become eligible.
What Does Part B Cover?
Medicare Part B helps pay for out-patient care deemed “medically necessary” for illnesses or medical conditions including doctor’s office visits, laboratory tests and more. The costs of some preventative care, such as flu shots, medical equipment including wheelchairs, oxygen, etc. are typically covered. Additional coverage may also include some outpatient mental healthcare, part-time in home skilled nursing care for the home-bound, and some prescription drugs including chemotherapy.
Getting services defined as medically necessary is important for those who are trying to get Medicare to pay those medical expenses. The best way to find out if a particular service is covered by Medicare Part B is to talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
You can also click here to find out if Medicare covers your item, service, or supply.
What Does Part B Not Cover?
Medicare Part B focuses on helping you pay the costs of medically necessary care when you are sick. Only in very limited situations does it cover any care for you eyes, teeth, or hearing.
Medicare Part B also does not cover medical care you receive outside of the United States, except in a few limited situations. If you frequently travel abroad, talk to an agent at Braden Insurance to make sure you have Medicare coverage that will travel with you.
Lastly, Medicare Part B does not cover the cost of help with the activities of daily like eating, bathing, and getting dressed.
What Providers Can I See?
You can choose any provider who is eligible to participate in Medicare, and who is accepting new patients.
Who Is Eligible for Part B?
As soon as you become eligible for Medicare, you can join Medicare Part B. Typically, eligibility is determined by age for those 65 or older, or individuals who have other qualifying conditions. Enrollment in Medicare Part B is optional but many people choose to enroll in Part B when they first become eligible.
How Much Does Part B Cost?
Medicare Part B is provided through the federal government, but you still pay a premium each month. Your Medicare Part B premium will be automatically deducted from your benefit payment if you get benefits from one of the following:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
If you don’t receive any of these benefits, then you will receive a bill in the mail.
Most enrollees pay the standard premium of $135.50 in 2019. If your modified adjusted gross income from your IRS tax return from two years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). The following chart lays out what premium certain levels of income have to pay.
|File individual tax return||File joint tax return||File married & separate tax return||You pay each month (in 2019)|
|$85,000 or less||$170,000 or less||$85,000 or less||$135.50|
|Above $85,000 up to $107,000||Above $170,000 up to $214,000||Not applicable||$189.60|
|Above $107,000 up to $133,500||Above $214,000 up to $267,000||Not applicable||$270.90|
|Above $133,500 up to $160,000||Above $267,000 up to $320,000||Not applicable||$352.20|
|Above $160,000 and less than $500,000||Above $320,000 and less than $750,000||Above $85,000 and less than $415,000||$433.40|
|$500,000 or above||$750,000 and above||$415,000 and above||$460.50|
How Do I Enroll in Part B?
All individuals who receive Social Security are automatically enrolled in Medicare Parts A and B when they reach the age of 65. If you choose to decline Medicare Part B or are not receiving Social Security, you will need to contact your local Social Security office.
Can I Be Denied Part B Coverage?
Assuming you are eligible for Medicare, you can not be refused Medicare Part B because of your medical history or a preexisting condition. The time when your coverage begins depends on when you sign up. If you sign up promptly at the start of the initial enrollment period, your coverage will begin on the first day of the month you become eligible for Medicare.
How Do I Renew My Part B Coverage?
Your Medicare Part B coverage renews automatically from year to year, so long as you pay the premium. Other than that, you do not have to do anything else!
Let Braden Insurance Be Your Medicare Experts
Having Medicare Part B or any Medicare coverage can mean the difference between getting critical medical care or staying ill. No one should have to choose.
The independent agents at Braden Insurance are here to make sure you get the Medicare coverage you need to maintain an active and healthy lifestyle. Talk to an agent today to make sure you are getting the coverage you deserve.