What is Medicare Part B?

Why is Medicare Part B so important?..

If you have been following our series, you know what Medicare Part A is, and know what it does and does not cover. We mentioned that Medicare Part A is part of Original Medicare, and Original Medicare has two parts. Those parts are Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). 

Medicare Part B (medical insurance) is a valuable asset and is available for beneficiary enrollment during the first 3 months before the beneficiaries birth month, the beneficiaries birth month, and 3 months after the beneficiaries birth month. If you ever wanted to enroll in a Medicare Advantage Plan or Medigap policy, you are going to need to have both Medicare Part's A and B. 

Medicare Part B covers beneficiaries with 2 types of services:

• Medical services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

more found on medicare.gov

Typically, Part B will cover things like:

• Ambulance
• Durable Medical Equipment
• Mental Health Services
• Preventative Services (i.e. Flu Shot)
• ​Some Prescription Drugs
• and much more...

If you want to get an exact answer on what will and will not be covered, Medicare Beneficiaries can use this online tool provided by Medicare's official website, link.

Medicare Part B needs to be applied for. It's not like Part A..

Unlike Medicare Part A, where majority of Americans get automatically by paying taxes to Medicare for 40 quarters (10 years), Medicare Part B needs to be applied for. 

Some beneficiaries will automatically qualify for Medicare Part B, but the majority will need to sign up for Part B. Those that want to know how to apply for Part B can apply here.

There is a late enrollment penalty if you choose to not enroll into Medicare Part B during your initial enrollment period

Part B does have a premium, but it is a standardized premium set by Medicare. It does not vary from state-to-state, but it does vary based on income. When applying during your 7 month for your Part B benefits, premiums will be deducted automatically from one of these:

• Social Security
• Railroad Retirement Board
• Office of Personnel Management

If you don’t get these benefit payments, you’ll get a bill. 

The standard Part B premium amount in 2020 is $144.60. Most people will pay the standard premium amount, but like mentioned earlier, if your income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago.

Some individuals may qualify for state funded assistance in the form of Medicaid or other, and typically will have some or all of their Part B premium.

Social Security can help determine if you qualify for extra help.

For those who don't know, and think that Original Medicare is sufficient enough insurance for there medical needs, there is a deductible and coinsurance responsibility to the beneficiary. In 2020, the Part B deductible was $198, and is subject to benefit periods. After the beneficiary met there deductible for the year, they are then responsible to pay 20% coinsurance of the Medicare-approved amount for:

• Doctor Services (including most doctor services while in the hospital)
• Outpatient therapy
• Durable medical equipment

Most individuals find themselves in a scenario where Original Medicare doesn't cover enough and it becomes too expensive to go to the doctor. It also doesn't cover prescription drugs. This is when beneficiaries decide to consider Medicare Advantage Plans or Medigap Policies. These plans help fill the gaps where Medicare leaves off, and they also offer this coverage at a much more affordable rate.

Our team of experts can help you get started in the initial phase of getting Part B and finding the right coverage that fits your specific needs. Feel free to reach out to us any time for question.