Medicare Part B is part of the original Medicare, which is an insurance plan offered by the United States government.
Medicare is split into four parts with different premiums and opt-in options: A, B, C (also called Advantage), and D. Part B covers most major medical expenses outside of hospital visits including doctor’s visits and certain medical equipment. Thus, it is a crucial supplement to Medicare Part A, covering hospital visits and inpatient treatments.
Many people are confused about what Part B covers, how much it costs, and whether it is worth it for their situation. Medicare is vital to understand the difficulties persons over the age of 65 and those with disabilities face. We’ll be covering those questions and more in the article. So, what is Medicare Part B?
A General Outlook on Medicare Part B
What Is Medicare Part B?
Medicare Part B covers medical services such as outpatient care and doctors’ services outside of a hospital visit. Part B is the first and perhaps most crucial optional part of your potential Medicare coverage. Beyond the above benefits, it also helps pay for medical services that aren’t strictly medically necessary but help with day-to-day living. It also covers preventative care services and extras such as exams, lab tests, diagnostic screenings, medical equipment, and ambulance transportation.
In 2021, the federal government set the Part B monthly premium at $170.10. This figure may be higher if your income is more than $91,000. Most people pay the standard premium amount. Although premiums can be expensive, the cost of waiting after becoming eligible can be even higher. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment fee. It is essential to seek out good advice about your particular situation and whether Medicare Part B is right for you.
Even with coverage, you’ll still have to pay 20 percent of the bills for doctor visits and other outpatient services. Keep this in mind when calculating your total expenses and what level of insurance coverage works best for your situation.
How It Compares to Other Parts of Medicare (A,C, and D)
Part A of Medicare is hospital coverage. If you apply for Medicare, you will automatically be enrolled in Part A. It primarily covers hospital visits, with some nursing care and hospice care included. Most people don’t pay a premium for Part A. However, there is a hefty deductible that has to be paid each time you visit the hospital. Part A is an essential part of healthcare coverage but is automatically applied once a person meets eligibility requirements and thus doesn’t need to be thought about beyond that.
Medicare Part C covers Medicare Advantage, which is the private health insurance alternative to federal medicare. This is coverage on top of both Part A and B, meaning you’ll have to pay the premium for B still. Then, you’ll be adding private insurance on top of that. This primarily covers dental and vision care. It can cover extras such as wheelchair ramps or shower grips for the home, meal delivery, and healthcare transportation. Most Part C plans also cover some prescription drugs but not a lot.
Medicare Part D is a fuller coverage of prescription drugs. This is covered by a private insurer and covers copays for each medication or a percentage of the prescription cost. However, You will still be responsible for 25 percent of the cost of your drugs if their total cost of the drugs is above $4,430 in 2022.
What Does Medicare Part B Cover?
Medicare Part B covers two main types of services:
- Medically necessary services: Those services and their supplies that are needed to diagnose and treat conditions that are considered essential within the accepted standards of medical practice.
- Preventative services: These are services meant to prevent illnesses or detect them at an early stage when treatment will be more effective.
More specifically, Part B covers the following list of items:
- Durable medical equipment (DME)
- Inpatient and outpatient mental health services
- Some outpatient prescription drugs
- Clinical research
To find out if the care you need is covered by Part B, you can talk to your health care provider about what services and supplies you need and ask if Medicare will cover them. Sometimes, you need something that Medicare usually covers, but won’t cover in your specific situation. This unfortunate situation will need to be discussed with your healthcare provider to find the best outcome that works for you.
There are several out-of-pocket costs for Medicare Part B, including an annual premium, a deductible, and coinsurance payments. Although Part B is beneficial in covering a wide variety of medical expenses, there are still many costs to be considered.
You can also do your research to determine if Medicare covers the specific service or supply you are looking for. For example, some websites carefully run down all the particular services and supplies covered by Medicare Part B. Getting medicare supplement insurance is always an option if others don’t suit you.
Who is Medicare Part B For?
Medicare Part B is for:
- People age 65 and older
- People with disabilities
- People with end stage renal disease (ESRD)
There are exceptions to these guidelines, but your health care provider will tell you if Part B is right for you and you don’t meet at least one of these criteria.
It is important for those who do meet one of these criteria to get enrolled and figure out your options sooner rather than later. Late penalties can occur when you wait too long to figure it out or have gaps in coverage. It is also important to coordinate with your work insurance or retirement insurance, as these can change your plans.
You must also qualify for Medicare Part A to be eligible for Part B. However, most people can enroll in Part B at the same time they are first eligible for Part A.
For Part A, you’ll need to have American Citizenship or have been a resident for at least five years before you are eligible for Medicare.
People 65 or Older
You automatically qualify for Medicare Part B once you turn 65. You can enroll up to three months before your 65th birthday to three months after. After this point, there may be late penalties.
Persons With Disabilities
If you have a disability and receive Social Security, you’re eligible for Medicare Part B regardless of age, but you can still decide on a good disability insurance.
Qualifying disabilities include:
- Digestive system disorders
- Cardiovascular and blood disorders
- Sensory disorders
- Neurological disorders
- Mental Disorders
Persons With ESRD or ALS
If you’ve been diagnosed with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you are also eligible for Medicare Part B regardless of age.
The Advantages of Medicare Part B
Medicare Part B covers essential medical care and supplies for the diagnosing, treating, and preventing of serious medical conditions. It expands upon Part A by covering care and treatments beyond those provided at a hospital.
When you should enroll in Medicare Part B depends on whether you or a spouse has a job-based or retirement insurance that can act in place of Part B. Once you lose such coverage, often around the age of 65 for most retirees, you’ll want to sign up for Part B. However, if you do not have such insurance at all, it is usually recommended that you enroll in Medicare Part B right when you are eligible.
Is Medicare Part B Worth It?
For most people over 65 who become eligible for Medicare Part B, the answer is yes. However, you should enroll in Part B right when you first become eligible, as if you miss your Part B deadline, you could be subject to late penalties.
Some individuals may still have to enroll in Part B to avoid the penalties, even if you have retirement insurance. This is because many retirement programs require it. Again, you can check with your company to confirm your particular situation.
If you are planning to waive your Medicare Part B due to retirement insurance, make sure you are not subject to late penalties for doing so later.
Once your retirement coverage ends, you’ll have eight months to enroll in Medicare. If you do not enroll within that eight-month period, you risk losing your coverage and may incur a lifetime late enrollment penalty.
Medicare’s Part B monthly premium for 2022 is $170.10. If you cannot afford this, there are programs to assist with payment. However, if you don’t take this coverage and have no employer coverage or retirement coverage, you will have to pay out of pocket for all doctor visits outside of a hospital. This is on top of the potential costs from late penalties from enrolling late.
Therefore, for the vast majority of people, Medicare Part B is worth it to avoid large costs down the line. It is especially important to take the coverage early so as to avoid any penalties.
Where Can I Find Out More and Get Advice on Medicare Part B?
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This article provides helpful guidance to better individual options for Medicare insurance and their different purposes. First, we’ve gone over the meaning of Parts A through D of Medicare and their different forms of coverage. Next, we’ve focused on Part B for this article, covering the optional premiums for doctor’s visits and other outpatient costs and supplies. This is essential coverage for persons with disabilities and those over 65 as it covers a large number of medical expenses outside of hospital visits.