Learn About Medicare Part B.

The federal government's Medicare program has two main parts, (not plans) and you guessed it right, its Medicare Part A and Medicare Part B.

They go hand in hand, each providing medical insurance for those eligible at age 65 or older, or by way of a disability. It's also available to anyone with end-stage-renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). 

Medicare Part B is optional and you may or may not need it depending on your particular circumstance. As an example, if you are intending on working past age 65 and your employer has 20 or more employee's you may have the option to continue the employer group health insurance plan until you retire. Therefor, you would want to delay your enrollment in Medicare Part B since it requires you to pay a monthly premium and you simply don't need it. 

Medicare Preventive Visit

Medicare Part B is for medical services outside of the hospital.

If you are intending on taking full Medicare benefits at age 65, then you'll want to enroll through Social Security. The sign up period, otherwise known as your Initial Enrollment Period (IEP), starts three months prior to your 65th birthday.

Why do I need Medicare Part B?

Remember, Original Medicare pays approximately 80% for approved services, and Part B of Medicare covers many of the healthcare needs you will most likely receive outside of a hospital. Everything from Primary Care doctor visits, to outpatient surgeries and more are covered under Part B. Here are some of the medical services covered under Part B of Medicare:

  • Doctor visits and medical exams
  • Diagnostic tests and screenings
  • Outpatient care
  • Medical equipment, such as walkers and wheelchairs
  • Ambulance services
  • Mental health services
  • Physical and occupational therapy

Medicare Part B is an important program for millions of Americans, and understanding it's basics is crucial for anyone who is eligible or will become eligible for the program. We can help answer all your questions about Medicare Part B and how to protect yourself from the unlimited 20% cost sharing. 

How to enroll in Medicare Part B

You'll only need to apply for Medicare Part B if you are not receiving Social Security or Railroad Retirement Benefits. In most cases the need to sign up for Part B arises when you are retiring after age 65 and your employer (more than 20 employees) group health coverage is ending.

For those who are turning age 65 and already are receiving Social Security or Railroad Retirement benefits, you will automatically be enrolled in both Original Medicare Part A and Part B.  

How much does Medicare Part B cost in 2024?

The premiums for Medicare Part B are set by the Federal Government every year. Sometimes they go up, and sometimes as in 2023 they went down. In 2022 the standard Part B premium was $170.10, and in 2023 the amount was reduced to $164.90 per month. Now in 2024 the standart Part B premium is $174.70

Remember, the Part B Premium is based on your income, and most people will pay the standard rate. However, if you earn a little more money than most, then you'll pay an additional premium known as IRMAA. The Income-Related-Monthly-Adjustment-Amount will be calculated automatically by Medicare based on what you, and your spouse earned two years prior to your Medicare eligibility. You'll be able to file a request to review and change your Part B premium as your income reduces into your retirement years.

For the big rollers who are Joint Tax Filers, their Part B premium could be as high as $594 per month! 

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What does Medicare Part B cover?

In general terms Part B coverage will pay for services outside of a hospital setting. More specifically Part B is for medical services provided by licensed physicians, and also includes outpatient services, durable medical equipment, preventative care, and home health services. Once the Part B annual deductible has been met then you are responsible for 20% of the total provider bill, but more importantly if you do not have some type of additional coverage there is no limit to how much you could actually end up paying. 

Medicare Supplement insurance and Medicare Advantage plans can help you reduce the risk of no-limit costs associated with original Medicare and we can help you with selecting the best coverage for your particular needs. 

Can I disenroll from Medicare Part B?

There are times when the retirement you've always dreamed about, sitting by the pool or playing golf every day just isn't enough and you want to return to the workforce for a few more years. In this scenario, you would request Medicare Part B disenrollment from Social Security. As long as your employer has over 20 employees and is offering their group health insurance plan then you'll be protected from any Medicare penalties. When the time comes, you can then re-enroll in Part B and any additional coverage like Medigap, Part D or Medicare Advantage. 

In order to avoid any late penalties, you'll need your employer to complete CMS Form L-456 which is proof of prior coverage. 

Medicare Part B late enrollment penalties & and how to avoid them.

Whether it's your grandkids soccer game or Medicare, the words 'receiving a penalty' are never good news. So why do so many end up with a late enrollment penalty from Medicare? It's simply because your window of opportunity to enroll in Medicare Part B has passed and you are now liable to pay extra. The best time to enroll in Medicare Part B is in your IEP or Initial Enrollment Period. For most people this is a seven month period around and including your birthday month. 

Example: Janet has her 65th birthday coming up next June. She can contact Social Security in either March, April or May preceding her June birthday month. She also has the three month period after June that includes July, August and September. That's a total of seven months to enroll in Medicare Part B for Jane. 

If you are past age 65 and still receiving employer group health insurance, and the group is larger than 20, then you will have a SEP or Special Enrollment Period to enroll in both Part A and Part B of Medicare. Most people will already have Medicare Part A when they turned 65 unless they choose not to activate it because they are still contributing to their Health Savings Account (HSA).  When you finally decide to retire, you'll have a total of eight months to enroll into Medicare and avoid the possibility of late enrollment penalties. 

IMPORTANT: Many employees will be given the option of COBRA extended health coverage from their employer. This type of coverage can last a total of eighteen months or more, but it does not protect you from potential Medicare Part B penalties. You must again enroll in Part B within eight months of losing your employer group health benefit. 

Questions & Answers

Does Medicare cover cancer diagnosis?

Medicare may have a maximum payment amount on certain types of services, and may not cover others. Your doctor may also recommend you get services more often than Medicare pays for, or they may recommend services that are not covered at all. Talk to us about additional cancer coverage to help with unexpected out-of-pocket costs associated with a cancer diagnosis.


Does Medicare cover annual routine physical examinations?

An Annual Wellness Visit (AWV) is part of Medicare's benefits to you and includes a discussion of your medical history, measurements of height, weight, blood pressure, and other assessments, it does not typically include a hands-on physical examination or diagnostic tests. The Annual Wellness Visit is not a thorough comprehensive physical examination.  


Does Medicare Part B include prescription drugs?

No, Medicare Part B does not cover most prescription drugs that you would typically receive at your pharmacy. Coverage for prescription medications is available through Medicare Part D, which is a separate prescription drug coverage program. Beneficiaries can choose a standalone Part D plan or enroll in a Medicare Advantage plan that includes Part D coverage. 

There are certain drugs and treatments covered under Medicare Part B if administered in a healthcare setting, such as a doctor's office, clinic, or hospital.


Can I use my Medicare Part B at any doctors office?

Medicare Part B gives you the freedom to choose any provider that accepts Medicare Assignment. Remember, there are no networks associated with Original Medicare Part A and Part B, just be sure that your provider accepts Medicare as a primary payor for services rendered. 


Does Medicare cover preventative services?

Yes, Medicare Part B covers a range of preventive services, including but not limited to, screenings for cancer, diabetes, cardiovascular conditions, bone density tests, and vaccinations such as the flu shot. These services are aimed at early detection and prevention of illnesses.


Medicare can be confusing for most. We want to help you navigate the many options available to you, so please call us directly at (800) 405-4802 and chat with our insurance advisors for help.

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