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Medicare Part B

Medicare Part B, a component of Original Medicare, provides coverage for medical services.

There are two types of services typically covered by Part B: medically necessary services, which include supplies and treatments needed to diagnose and treat a specific medical condition that meets the accepted standards of medical practice, and preventive services, such as health care to prevent illness or detect it early when treatment is most effective.

For most preventive services, if you receive them from a healthcare provider who accepts assignment (meaning they agree to be paid directly by Medicare), you will likely not have to pay anything out-of-pocket.

Medicare Part B Benefits

Medicare Part B provides coverage for various outpatient medical services, including preventive services such as cancer screenings, vaccinations, and lab tests. Additionally, it covers mental health services and durable medical equipment.

Moreover, Part B also covers certain services that are provided during inpatient hospital care, in addition to the coverage provided by Part A. These services include diagnostic tests, surgeries, dialysis, chemotherapy, and injected medications.

Part B Covers Things Like:

  • Ambulance services
  • Durable medical equipment
  • Mental Health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Limited outpatient prescription drugs
  • Clinical research

Coverage Not Included in Medicare Part B

Medicare Part B has limitations when it comes to coverage. It does not provide benefits for routine dental, vision, or hearing services. Additionally, it does not cover treatments that are not deemed medically necessary, such as cosmetic surgeries, acupuncture, acupressure, and homeopathy. Part B also excludes outpatient prescription drugs, most vaccinations and immunizations, and alternative medical care.

In essence, Part B only covers a portion of medical expenses, outpatient hospital and clinic fees, laboratory work, some home health care, physical and speech therapy, a limited number of drugs, and medical supplies.

How Much Does Medicare Part B Cost?

Calculating the cost of Medicare Part B involves taking into account several factors. In addition to a monthly premium, there is an annual deductible and coinsurance to consider. After the deductible is met, Part B covers 80% of the cost of covered services.

As of 2023, the standard monthly premium for Medicare Part B is $170.10. However, higher earners may pay more based on their adjusted gross income. If an individual is already receiving Social Security, Railroad Retirement, or Office of Personnel Management benefits, the Part B premium will be deducted from those checks. Otherwise, Medicare may send a monthly bill, which can be paid using Easy Pay or other methods.

The annual deductible for Part B in 2023 is $233. It’s important to note that both the premium and deductible can change from year to year.

What Copays Does Medicare Part B Have?

Part B does not have any copays.

Who is Eligible for Premium-Free Part B?

The qualifications for Medicare Part B are similar to those for Part A and if you qualify for Medicare Part A without a premium, you’re also eligible for Part B. While most individuals pay a monthly premium for Part B, some lower-income beneficiaries and those who are eligible for both Medicare and Medicaid can qualify for premium-free Part B through the Medicare Savings Program.

The Standard Eligibility Requirements for Part B are:

  • You’re a U.S. citizen or a permanent legal resident who has lived in the U.S. for more than five years
  • You are 65 or older
  • You have been on Social Security Disability Insurance (SSDI) for two years
  • You have end-stage renal disease (ESRD)

How to Apply for Medicare Part B

Individuals who have been receiving Social Security benefits prior to turning 65 will be automatically enrolled in both Medicare Parts A and B. The Medicare ID card will be sent to their mailing address the month before their 65th birthday. However, those who are not currently receiving Social Security benefits must apply for Medicare benefits themselves, either by submitting an online application or calling the Social Security Administration office.

The Initial Enrollment Period for Medicare Parts A and B starts three months before an individual’s 65th birthday and continues until three months after their birthday. Failure to enroll during this period, unless the individual has other creditable health coverage, will result in a penalty.

However, if the individual qualifies for a Special Enrollment Period, they will not incur a penalty. This enrollment period is applicable to those who did not enroll at age 65 but had other creditable health insurance. It is advisable to explore other enrollment periods to gain more insight into your enrollment options.

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