Medicare Part B

Medicare Part B, part of Original Medicare, is a federal health insurance program that covers a range of medical services. It includes coverage for annual wellness visits, laboratory tests, bloodwork, x-rays, medical equipment, mental health services, and ambulance transport. Typically, under Part B, you are responsible for paying 20% of the Medicare-approved amount for each covered service or item. However, it does not cover dental, hearing, or vision exams, hearing aids, glasses, emergency care outside the U.S., long-term care, or prescription drugs. Additionally, Medicare Part B requires a monthly premium.

Medicare Part B Covers

Medicare Part B generally covers a variety of outpatient services, including but not limited to:

Doctor’s office visits
Preventive care
Chemotherapy
Physical therapy
Flu shots
Pneumococcal shots
Outpatient mental health care
Diabetes screenings, supplies, and self-management training
Durable medical equipment
Alcoholism counseling
Some dermatological services (when deemed medically necessary)

What does Medicare Part B Not Cover

Medicare Part B does not cover certain healthcare services, but Medicare Advantage (Part C) plans may include coverage for:

Long-term care
Prescription drug plans
Routine hearing, dental, and vision exams
Fitness club memberships
Hearing aids and glasses
Emergency assistance outside the U.S.

Medicare Part B Costs

Medicare Part B requires a monthly premium and a yearly deductible before coverage starts. Your costs for enrolling in Part B will include the monthly premium, coinsurance (the portion of the cost that Medicare does not cover), and an annual deductible. For 2023, the standard monthly premium is $164.90, though it can be higher for individuals with higher incomes. The annual deductible for Part B is $226, and you are also responsible for paying 20% of the Medicare-approved amount for covered services as coinsurance.

Medicare Part B Eligibility

Eligibility for Medicare Part B follows the same guidelines as Medicare Part A. To qualify, you must be 65 years of age or older and a U.S. citizen. Legal permanent residents who have lived in the United States for at least 5 consecutive years are also eligible. Additionally, individuals diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) can apply for Part B. Furthermore, those under 65 with specific disabilities that significantly impact daily living and require extensive care may also be eligible.

Medicare Part B Enrollment

All beneficiaries of Medicare Part A are also eligible to enroll in Part B. If an individual is not eligible for Part A but is 65 years or older, they can still sign up for Part B if they are either a U.S. citizen or a lawful permanent resident who has lived in the United States continuously for the past 5 years. Those who are automatically enrolled in Medicare Part A will also be automatically enrolled in Part B. However, since there is a monthly premium for Part B, beneficiaries have the option to decline enrollment if they choose.

If you have health insurance through an employer with more than 20 employees, you qualify for a Special Enrollment Period. This allows you to sign up for Part B when you lose your employer coverage or cease employment. If you enroll within the eight-month Special Enrollment Period, you will avoid late enrollment penalties.

Late Enrollment Fees

Medicare Part B imposes a late enrollment penalty of 10% of the standard premium rate for each 12-month period you go without signing up. This penalty is applied for as long as you have Part B coverage. In 2023, the standard premium rate for Part B is $164.90. For example, if you delay enrollment by two years, your monthly premium will increase by 20%. In this case, the late enrollment penalty would amount to $33 per month (10% of $164.90 is $16.49, and multiplying this by 2 years gives $33). Therefore, if you enroll two years late, your monthly premium would be $197.90 ($164.90 plus $33) for as long as you have Part B coverage.