Medicare Part B, also known as medical insurance, is the part of your Original Medicare insurance plan that covers medical services such as doctor visits and outpatient procedures.
What does Medicare Part B Cover?
- doctor office visits
- outpatient care and procedures (such as cancer treatment)
- diagnostic screenings (such as mammograms, diabetes screenings)
- medications the doctors administer themselves
- lab tests
- second opinions
- medically necessary services
- preventative services (such as flu shots and pneumococcal shots)
- ambulance services
- mental health services (such as alcohol counseling)
- clinical research
- medically necessary supplies
- some durable medical equipment (such as wheelchairs)
- physical therapy
- cardiac rehabilitation
How much does the Medicare Part B premium cost?
Medicare Part B has a premium, set by the federal government, of $179.10 per month for most people in 2022. If you are drawing social security, this premium will be deducted from your social security. Otherwise, you will be billed for it. In addition to this, if your income is above $91,000, you may have to pay a higher premium called an IRMAA (Income Related Monthly Adjustment Amount). This is based on your income from 2 years prior. More information on the IRMAA based on your income bracket can be found here: IRMAA information.
What are the Part B deductibles, co-pays, and co-insurances
The annual deductible for Part B is $233 in 2022. When the deductible has been met, Medicare pays 80%, and you pay 20% of the Medicare-approved cost. Unfortunately, there is no limit on this cost. However, a Medicare Supplement plan or Medicare Advantage plan can help cover these additional costs.
If a provider accepts Medicare assignment, they agree to accept the Medicare approved amount as full payment for their services. In contrast, if a doctor is not on Medicare assignment, they may charge an excess charge of 15% in addition to the Medicare approved amount.
Example: Julie is on Original Medicare only. She has a heart attack. Because of this, Julie needs open heart surgery, which costs $100,000.
If the surgeon is on Medicare assignment:
- Julie pays a deductible of $233 (in 2022)
- $100,000-$233 = $99,767
- Then, Medicare pays $99,767 x 80% = $79,813.60
- Julies pays $99,767 x 20% = $19,953.40
Julie’s total out of pocket cost: $19,953.40 + $233 = $20,186.40 (this does not including Part A, Part D, or additional costs that may not be covered by Medicare).
However, if the surgeon is not on Medicare assignment, he can charge an extra 15%. For this example he charges $15,000. Julie must also pay this amount.
Plans are available to help cover these extra costs
Most people will choose a Medicare Supplement Plan or Medicare Advantage (Part C) plan to help cover the deductibles, co-pays, and co-insurances that Medicare Part B does not cover. You can learn more about these coverage options and pros and cons of each on the article we wrote here:
When can I enroll into Medicare Part B?
Like Medicare Part A, you’re eligible to enroll in Medicare Part B during your Medicare Initial Enrollment Period (IEP). This is a 7-month period. It is the three months before the month of your 65th birthday, your birthday month, and the three months after the month of your 65th birthday.
John’s birthday is September 12, 1955. Therefore, his Initial Enrollment Period begins June 1st, 2020 and ends December 31, 2020.
Social security will automatically enroll you into Medicare Part B if you are receiving Social Security or Railroad Retirement Board benefits.
Some people may qualify for Medicare Part B before turning 65. This is true with certain disabilities or for those with ALS or ESRD. Restrictions may apply.
What is the Part B Late Enrollment Penalty
If you don’t have creditable coverage from another insurance plan, and do not enroll in Medicare Part B during your Initial Enrollment Period, you may face a late enrollment penalty when you do enroll in Medicare Part B.
It is important to note that if you do have creditable coverage, it may be beneficial for you to delay enrolling in Part B. Examples of creditable coverage are:
- you are still working and have insurance through your employer plan, and your employer has over 20 employees
- You are covered by your spouse’s employer health insurance plan, and that employer has over 20 employees
- Veteran benefits such as Tricare For Life
Restrictions may apply. ALWAYS check with the plan administrator that handles the employer plan to ensure that your coverage is creditable. If it is not creditable, it is suggested you go ahead and enroll in Medicare Part B.
Thriving Seniors is here to help you with your enrollment process. Our services are 100% free of charge! Call us today at 1-808-650-5939 to speak with a licensed, independent insurance agent. You can also contact us via email by filling out our form on our contact us page.
Our office is located in Honolulu, HI and licensed in multiple states. We offer our services by appointment in person, over the phone, or by video call. We look forward to helping you!