Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. works with Part AMedicare Part A, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility, or other inpatient services. Medicare Part A is one of the pain parts of Original Medicare. to make up Original MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance)..
Part B helps cover medical services. These services can include medical treatment, preventive services, durable medical equipment, and vaccines.
You are eligible to enroll in Medicare Part B the year you turn 65, but some circumstances allow you to sign up before and after 65.
The Part B monthly premiumA premium is a fee you pay to your insurance company for a health plan coverage. This is usually a monthly cost. for 2021 starts at $148.50 and is income-based. Your final Part B cost also includes a deductibleA deductible is the amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. and out-of-pocket coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. The remaining amount is paid by your insurance company. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you'll pay $200. Your insurance company will cover the final $800..
If you have Original Medicare, Part B provides a good amount of the benefits you probably associate with your healthcare. And, since Medicare Advantage (Part C) must provide at least the same level of coverage, it’s a topic all Medicare beneficiaries should understand. Here’s what you should know about Medicare Part B.
Medicare Part B is also known as Medicare’s medical coverage. It’s partially funded by the federal government and is available to all legal U.S. citizens and residents that are 65 and older. Medicare Part B provides outpatient medical services, preventive services, vaccinations and immunizations, and specific medical equipment. Part B works with Part A to provide Original Medicare coverage.
What is the purpose of Medicare Part B?
It sounds like a philosophical question, but Medicare Part B has a particular function: to help Americans 65 and older pay for their medical bills. As one-half of Original Medicare, Part B is funded through tax dollars and is run by the federal government. The goal is not only to offer treatments for illnesses and other medical conditions but to help bolster the health of older Americans with a robust set of preventive services designed to stop illnesses before they start. Medicare Part B also helps pay for equipment you may need as part of your care, including items like wheelchairs and CPAP machines. More on that later.
Parts A and B often get mentioned together as the two halves of Original Medicare. Together they form the basis for what all Medicare plans are required to offer, including Medicare Advantage (Part C). Coverage from Part A and Part B is not interchangeable, and you’ll want to know the differences between the two. Here’s an overview:
Part A vs. Part B
Medicare Part A
Often called “hospital insurance,” Part A helps cover the costs you incur when receiving inpatient medical care. This is care that involves an overnight stay in a hospital. Part A can pay a portion of your bills if you receive specific medical care in a skilled nursing facility. Services received in a medical facility must be medically necessary for Medicare to pay any portion. For example, cosmetic surgery that requires a hospital stay typically isn’t covered by Part A.
Medicare Part B
Part B provides the “medical insurance” half of Original Medicare when you receive outpatient care that doesn’t require a stay in a hospital or other medical facility. Part B covers visits to a doctor, plus an extensive menu of preventive services that you can receive in an outpatient setting. Medicare Part B may cover equipment used outside of hospital walls. In other words, Medicare Part B helps cover much more than just the trips to your doctor’s office.
The standard answer is during the year you turn 65. If this is your first chance to enroll in Medicare Part B, you need to sign up during your Initial Enrollment Period (IEP). For most people, your IEP starts three calendar months before the month you turn 65 and closes three calendar months after. However, if you were born on the first of the month, then your IEP starts four calendar months before the month you turn 65 and closes two calendar months after. Not enrolling during your IEP means you’ll be stuck paying an enrollment penalty on your Part B premium for as long as you have your policy.
Enrolling in Medicare Part B before 65
Not everyone has to wait for 65 to enroll in Medicare Part B. Medicare has special provisions that allow certain beneficiaries to enroll early. If you’ve received disability-based Social Security for 24 months, you may be eligible. Those who have received Railroad Retirement Board (RRB) benefits for 24 or more months may also enroll before 65. Medicare will also extend Part B benefits to those living with certain conditions, including:
- End Stage Renal Disease (ESRD)
- Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s Disease
If you qualify for Medicare because of Social Security or RRB benefits, you may be automatically enrolled in Part A only. If so, you’ll need to sign up for Part B separately. To see if you need to enroll in Part B and you’re younger than 65, call the Social Security Administration. If you have rail benefits, contact the RRB.
Delaying your Part B enrollment
You may be able to delay your Medicare enrollment if you’re receiving group health benefits through an employer when you turn 65. If you’re still working when your IEP comes around, sticking with your employer’s plan may be more cost-effective. If so, you can stay on the plan and enroll in Medicare when it ends. When this happens, a Special Enrollment Period will open. This will give you eight months to enroll in Original Medicare (Parts A and B) without incurring a Medicare late enrollment penalty.
The decision to delay your enrollment is more complicated than whether you can afford your current plan. Once you turn 65, your employer’s plan and Medicare will decide which side should pay the majority of your medical bills as the primary payer and which should pay the rest. Depending on the size of your company, letting Medicare pay its portion may provide more financial flexibility for all sides.
Employers with 20 or more employees generally take the role of primary payer when covering workers aged 65 and older. If you work for a larger employer like this, it may make the most sense to delay your enrollment until you lose your coverage.
Employers with fewer than 20 employees are generally the secondary payer behind Medicare, which helps relieve some of the cost burdens for smaller companies. If your group plan is the secondary payer, it will start covering what Part B does not. While you can delay your enrollment, it may not make sense if you work for a company with fewer than 20 employees.
How do I enroll in Medicare Part B?
Whether you’re approaching 65 or are looking to enroll for the first time during a Special Enrollment Period, there are several ways to sign up for Part B. Medicare enrollment happens through the Social Security Administration. Remember, you can begin this process as early as three calendar months before the month you turn 65 if you’re enrolling during your IEP. If you’re enrolling because your other coverage has ended, you have eight months to enroll without a penalty.
Need to enroll in Medicare Part B? You can do so:
- Over the phone at 1-800-772-1213 (TTY 1-800-325-0778)
Are you or a loved one signing up for Medicare for the first time? GoHealth has several Learning Guides designed to make the process a little easier. You’ll find:
When Can I First Enroll in Medicare Part B?
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You can enroll between December 1, 2020, and June 30, 2021.
Contact a GoHealth Licensed Insurance Agent
Our goal is enroll you in a plan that is right for you, lowers your costs, and gives your the most benefits (like prescriptions, vision, hearing and/or dental) that you are entitled to.
Your Medicare Initial Enrollment Period is Closed.
Most people have seven months to first enroll in Medicare. Your initial enrollment period was between January 1, 2020 and July 31, 2020.
Yes, Medicare beneficiaries generally have to pay for their Part B coverage. This differs from Medicare Part A, which is often provided at no monthly cost if you (or your spouse) worked 10 or more years.
Medicare Part B requires a monthly payment for coverage. This is called your Part B premium, and it increases with your income. You’ll also need to pay coinsurance when you receive medical services, but only after you’ve met your entire Part B deductible.
That’s a lot to learn about Part B costs. Here’s a quick overview:
What is the Part B premium?
Your Part B premium is your monthly payment for Medicare’s medical coverage. If you receive Social Security benefits, it’s typically withdrawn from your benefits each month.
The Part B premium in 2021 starts at $148.50 per month for adults making up to $88,000 per year. Couples who file a joint tax return can make up to $176,000. If you make more than this, you’ll have to pay an Income-Related Monthly Adjusted Amount (IRMAA) on top of your monthly premium. For the highest earners, this can balloon your Medicare Part B premium to $504.90 each month. Most beneficiaries, however, pay the standard Part B premium amount.
What is the Part B deductible?
You’ll need to pay your entire Part B deductible before Medicare pays its portion of your medical bills. In 2021, that amount is $203. This applies to pretty much all Part B benefits, including medical services, durable medical equipment, and therapy services. Preventive services, however, are provided at no cost and do not count toward your deductible.
Your Part B premium and deductible can change from year to year. Medicare adjusts its rates based on data gathered by the Centers for Medicare and Medicaid Services (CMS).  If you’re an Original Medicare beneficiary, you’ll receive notice of your rate adjustments in the mail.
What are Part B copays and coinsurance?
Once you’ve paid your deductible, Medicare will begin to pay its portion for your Part B benefits. What does this mean? Medicare generally pays 80% of the cost for Medicare-approved services you receive that are deemed medically necessary by your doctor. You’re then responsible for paying the remaining 20%, or coinsurance. That means if your provider charges $100 for a doctor visit, Medicare will pay $80. You will pay the provider $20.
If you have Medicare Advantage (Part C), you’ll receive at least the same services and benefits that you’d get from Part B. Many insurance companies that provide Part C charge different amounts and use different payment structures than Medicare. One of these is a copayment; instead of charging beneficiaries a percentage of their Medicare-approved costs, copays are flat-rate payments. If you have Part C and receive a service that costs $500, you may only pay a copay.
Can I review how much I pay for Part B?
If you’re an Original Medicare beneficiary, you’ll receive an overview of your Part B coverage in the mail every three months. This is known as a Medicare Summary Notice (MSN), and it has some very helpful information. It will list all the services and supplies prescribed in your name over that three-month timeframe, how much Medicare paid, and the amount billed to you. Your MSN is not a bill — think of it more as a statement that shows your current Medicare standing. Reviewing your MSN is also a great way to identify and prevent fraudulent services charged to Medicare in your name.
No; Medicare Part B offers a wide range of benefits aside from doctor services. If you have Part B, Medicare can help cover some vaccines, preventive treatments and services, and even equipment you may need. A Medicare-approved physician will need to determine they’re medically necessary. If not, you may end up paying full price.
Here are a few examples of the different services covered by Medicare Part B:
Preventive services and screenings
Durable medical equipment
Vaccines and immunizations
Many of the services above may be administered during a hospitalization. In this case, your service may be classified as “inpatient.” This can affect how Medicare covers and pays for these treatments. For example, chemotherapy that requires you to stay in a hospital or other facility may be covered by Part A. If so, you’ll have a different deductible and coinsurance rates to know about. To see how your service is covered, ask your doctor.
Every item and service covered by Medicare must go through an approval process that includes the physician and Medicare. When equipment is needed, the supplier also must be vetted and approved by Medicare. When trying to figure out Part B coverage, it can be more helpful to learn what’s not covered by Medicare.
Here are a few items Medicare typically doesn’t cover:
Also called custodial care, long-term care refers to assistance you may need to complete everyday tasks. These include dressing, bathing and eating. If this is the only service you need, Medicare typically won’t pay for it unless you receive custodial care as part of a larger service.
Part B will cover medications in very limited instances (more on that below). For standard prescription drugs, you’ll need to enroll in a Medicare Prescription Drug Plan (Part D). Offered by private insurance companies, Part D plans must be added separately from Parts A and B. They also have their own premiums, deductibles and coinsurance.
Most dental care, including dentures
Medicare doesn’t consider dental care medically necessary. If you have Original Medicare and need dental services, including cavity fillings, checkups, or dentures, you’ll need to add stand-alone dental coverage.
Hearing and eye care
Medicare Part B doesn’t offer much help when it comes to your vision and hearing needs, either. Medicare won’t cover hearing tests or hearing aids, nor will it help pay for vision checks needed to fit you for glasses. In all of these cases, you’ll need to purchase separate, stand-alone coverage.
Medicare will not pay for procedures that are not medically necessary. While many cosmetic procedures may include intensive surgery and recovery periods, you’ll be responsible for paying all of your costs if you receive purely cosmetic care. The Part B deductible and coinsurance will not come into play.
If you need services like these, you’ll need to purchase additional coverage that offers these benefits. You can also consider switching from Original Medicare (Parts A and B) to Medicare Advantage (Part C). Medicare Advantage replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.
If you’ve ever heard the term “Part B drug,” it typically refers to the limited drugs covered by Part B. For the most part, medications are covered only by Part D. If you receive medication as part of an inpatient or outpatient service, it may be covered by Part B. Medications that are used with durable medical equipment, for example, are often covered, as is chemotherapy received in outpatient therapy.
Here are some more examples of drugs covered by Medicare Part B:
- Injectable drugs for osteoporosis
- Erythropoiesis-stimulating agents
- Blood clotting factors
- Injectable drugs
- Oral End-Stage Renal Disease (ESRD) drugs
- Intravenous and tube feeding
- Intravenous Immune Globulin (IVIG) provided in-home
If you still have questions about Medicare Part B, give GoHealth a call. Our licensed insurance agents can help explain what Part B is, what it does, and help you decide whether it’s the right option for you.
Can I use Medicare Part B anywhere?
If you’re enrolled in Original Medicare (Parts A and B), your coverage is accepted anywhere in the country that accepts Medicare. If you’re traveling out of state and become sick, you are not limited to providers near your home. Medicare is run by the Social Security Administration, which is a federal program. Because of this, you can use your Medicare coverage across the nation.
What if I can’t afford Part B?
Medicare has several options for beneficiaries that can’t afford their healthcare. The most recognized is Medicaid. Medicare and Medicaid are not the same things; Medicaid is health insurance for adults, children, and families with limited incomes and resources. Medicaid programs are run by the states and have different qualifications and benefits based on where you live. There are also times when Medicare and Medicaid will work together to cover your medical bills. This is known as dual eligibility.
If you need financial assistance but your income is too high for Medicaid, you may have other options. Medicare Savings Programs are state programs that receive federal funding to help beneficiaries pay for their Part B costs. If you qualify, you can get help paying for your Part B premium, deductible and out-of-pocket costs.
Does my Part B plan cover my spouse?
No; even though your monthly Part B premium payment is decided by factoring in both of your incomes, Medicare is an individual health policy only. There are no family plans as there are with regular health insurance. You and your spouse will need to enroll in, and pay for, your Part B policies separately.
What do I do if I miss my Initial Enrollment Period?
The first thing will be to see if you qualify for a Special Enrollment Period. If not, you’ll need to enroll during your next available enrollment period. In this case, it’s the General Enrollment Period (GEP) for Part B. The GEP is held each year from January 1 to March 31. If you enroll during this time, your policy will become active on July 1.