What Does Medicare Part B Cover?
Medicare Part B covers various types of preventive care, like medical health screenings, certain types of vaccines, mental health counseling, Ambulance services, Durable Medical Equipment (DME), Mental Health & Inpatient-Outpatient & Partial hospitalization.
What Medicare Part B Covers
- Doctor Services
- Emergency room services
- Clinical research
- Laboratory work
- Imaging and other diagnostic screenings
- Emergency transportation (ambulance)
- Durable medical equipment (wheelchairs, oxygen tanks, etc.)
- Mammograms (screening)
- Inpatient and outpatient care for mental health
- Partial hospitalization for mental health
- Kidney dialysis
- EKG Screening
- Occupational therapy
- Physical therapy
- Hepatitis B Shots
- HIV Screening
- Home Health Services
- Flu shots
- Foot Exams and Treatment (Diabetes-related)
- Glaucoma Tests
- Hearing and Balance Exams
- Pap Tests and Pelvic Exams (includes clinical breast exam)
- Visit hss.gov for a complete list of Part B covered services.
Medicare will start sharing the cost of preventative care and medical services after the deductible is met.
The deductible for Medicare Part B is also standardized, which means all beneficiaries pay the same deductible every year. The deductible doesn’t change regardless of income. You pay this deductible by covering needed doctor services out of pocket at the beginning of each year.
Part B Deductible:
For 2023, the deductible for Part B is $226.00.
Once you meet your annual deductible, Medicare will start sharing the cost of covered services with you. In most cases, you will pay 20% coinsurance, which means Medicare pays 80% of Medicare-approved costs. Medical professionals who accept Medicare assignments should only charge the prices approved by Medicare.
How much you pay in coinsurance and copayments depends on how often you visit the doctor and what services or medical equipment you need.
What Medicare Part B Doesn't Cover
- Long-term care
- Dentures or dental implants
- Cosmetic surgery
- Routine foot care
- Hearing exams for hearing aid fittings
- Most eye exams
- Most dental care
- Full prescription drug coverage
The fastest way to determine if testing, services, or medical equipment are eligible for Part B coverage is to use the search feature at Medicare.gov. Enter the item or service that you need to see if it’s covered by Part B. Your doctor should also know this information or find out for you.
Beneficiaries can apply for Medicare Part D if a prescription drug plan is needed. In addition, some Part C Medicare Advantage Plans will also include prescription drug coverage.
Medicare Part B Eligibility
There are three general ways to qualify for Medicare Part B:
- Reach the age of 65 and qualify for premium-free Medicare Part A. Your eligibility for Part B comes along with Part A eligibility. You will only pay a monthly premium for Medicare Part B.
- Reach the age of 65 and meet the requirements for Medicare Part A even though you don’t qualify for premium-free Part A. You must live in the U.S. and show proof of citizenship or legal permanent residency. You will pay a monthly premium for Part A in addition to your Part B premium.
- Receive disability benefits from the Social Security office or the Railroad Retirement Board (RRB) for at least four months due to permanent disability. Your eligibility for Original Medicare is opened regardless of age.
- Receive a diagnosis of end-stage renal disease. Eligibility for Original Medicare is immediate.
In most cases, you need to enroll in Medicare Part A to qualify for Medicare Part B. Part A is the hospital insurance that covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care. Medicare Part A and Part B are the primary parts of Medicare and offer the minimum Medicare coverage available.
Medicare Part B Cost
The full Part B cost includes three categories of expenses:
- Monthly premium
- Annual deductible
Some beneficiaries can reduce the cost of Medicare Part B by also qualifying for Medicaid services. Each state determines eligibility for Medicaid.
Medicare Part B Monthly Premium
The monthly premium is required to keep your Medicare Part B policy active. The rate is standardized by the government and can change every year.
Individuals who earn more than $97,000 a year or couples who earn more than $194,000 a year are required to pay an Income Related Monthly Adjustment Amount, or IRMAA. There are six tiers with their own monthly premium based on income and tax filing status.
For 2023, the standard Part B premium is $164.90. Most people pay the standard Part B premium amount.
Rates for beneficiaries with higher income range from $238.10 to $578.30.
|File individual tax return
||File joint tax return
||File married & separate tax return – 2020 Income||You pay each month (in 2023)|
|$97,000 or less||$197,000 or less||$97,000 or less||$164.90|
|above $97,000 up to $123,000||above $194,000 up to $246,000||Not applicable||$230.80|
|above $123,000 up to $153,000||above $306,000 up to $366,000||Not applicable||$429.60|
|above $153,000 up to $183,000||above $246,000 up to $306,000||Not applicable||$329.70|
|above $183,000 and less than $500,000||above $366,000 and less than $750,000||above $91,000 and less than $409,000||$527.50|
|$500,000 or above||$750,000 or above||$409,000 or above||$560.50|
When Can I Enroll in Medicare Part B?
If you receive RRB or Social Security benefits, you will most likely receive automatic Medicare Part A and Part B enrollment. Your coverage should start the first day of the month you turn 65 or the first day of the previous month if your birthday is on the first day of the month.
If you aren’t receiving disability benefits from Social Security or the RRB, your first and best chance to enroll in Medicare Part B is your initial enrollment period. It lasts for seven months, including the month of your 65th birthday and the three months preceding and following. For example, if you turn 65 on May 5, your initial enrollment period will open on February 1 and close on August 31.
If you want your health insurance to start when you turn 65, apply during the first three months of the initial enrollment period. Applying during your birthday month or after will cause a delay in coverage.
- Apply during birthday month – coverage starts 1 month after enrollment
- Apply the month following birthday month – coverage starts 2 months after enrollment
- Apply 2 or 3 months after birthday month – coverage starts 3 months after enrollment
Special Enrollment Periods
If you don’t enroll in Medicare Part B during your initial enrollment period, you may qualify for a special enrollment period. This short period allows you to enroll without paying a late enrollment penalty. However, it’s only available for beneficiaries with qualifying circumstances. The most common reason is beneficiaries who delay Part B enrollment because they have full health care coverage through an employer when they turn 65.
General Enrollment Period
If you miss the initial enrollment period and don’t qualify for a special enrollment period, then you will wait until the next general enrollment period. This period goes from January 1 to March 31 every year. The start date for benefits is July 1.
You may pay a late enrollment penalty that equals 10% of the Part B premium for every year you were eligible for benefits but did not enroll. For example, if you wait three years to enroll in Medicare Part B and don’t qualify for a special enrollment period, you could pay 30% more for your premium than you would have paid if you enrolled when first eligible.
How long does it take to get Medicare Part B after applying?
- It depends on when you enroll in Medicare Part B. The following chart will help you determine your most likely Part B start date. First 3 months of initial enrollment period – 1st day of 65th birthday month or 1st day of previous month if your birthday is on the first day of the month
- During birthday month – 1 month after enrollment
- One month after birthday month – 2 months after enrollment
- Last 2 months of initial enrollment period – 3 months after enrollment
- During special enrollment period – First day of the month following receipt of your request
- Late enrollment during general enrollment period – July 1 of the year you apply – may go back up to six months or up to the first day you were eligible for benefits
Do I have to pay for Medicare Part B if I have other insurance?
- If you have other medical coverage through an employer, spouse, or other suitable resource, you can delay enrollment in Medicare Part B. You can apply for a special enrollment period when you lose that coverage, allowing you to enroll in part B without penalty.
- Keep in mind that not every health plan is suitable for Medicare purposes. For instance, you cannot receive a special enrollment period for delaying Part B enrollment if you have a COBRA policy. Make sure the coverage you have is acceptable before delaying enrollment in Part B.
Is Medicare Part B eligibility based on income?
The amount you pay for the Part B premium is based on income, but general eligibility is not. If you’re qualified to enroll in Medicare Part A, you are also eligible for Part B. You may just pay more per month if your income is above designated thresholds.
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