Medicare Part B Eligibility
Written by: Rachael Zimlich, RN, BSN
Reviewed by: Brett Braithwaite, Licensed Insurance Agent
Generally, you are eligible for Medicare Part B when you turn 65 or meet certain criteria.
Some people are automatically enrolled in Medicare Part B.
You can only enroll in Medicare Part B during certain times of the year, or enrollment periods.
Even when you are eligible for Medicare Part B, you will have to pay for a share of your outpatient healthcare costs. These include a premium , deductible and coinsurance.
Between what it helps cover and its different costs, there’s a lot to know about Medicare Part B. Few details are as important to understand, however, as Medicare Part B eligibility. Knowing who is eligible for Medicare Part B reimbursement — and when you’re allowed to enroll — won’t just help you find the right plan, it can save you from potential headaches down the road.
Signing up for Medicare can seem confusing because there are several parts to the coverage. Medicare Parts A and B make up Original Medicare, and you are eligible for both parts of the program at the same time — generally when you turn 65. On this page, we’ll discuss Medicare Part B eligibility, who is not eligible for Medicare Part B, and other key details you’ll need to know.
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When Is a Person Eligible for Medicare Part B Benefits?
Medicare Part B is the part of Original Medicare that covers outpatient care and preventive care services. This also includes some medical equipment and therapy sessions. If you’re nearing 65, you may have asked: “When am I eligible for Medicare Part B?” The answer? You generally become eligible for Original Medicare — Parts A and B — when you turn 65. The enrollment period when you are typically first eligible is your Initial Enrollment Period. This includes:
- Three months before you turn 65
- The month you turn 65
- Three months after your turn 65
Age isn’t the only qualifier, however; if you’re under 65 and meet these Medicare Part B eligibility requirements, you may be able to receive benefits:
- If you have been receiving disability benefits from the Social Security Administration for more than 24 months
- If you have been receiving disability benefits from the Railroad Retirement Board for more than 24 months
- If you have End-Stage Renal Disease (ESRD)
- If you have received a kidney transplant
Also, if you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease) and qualify for disability, you will be eligible for Medicare Part B the first month your disability payments begin. Unlike with other disabilities, you do not need to wait for 24 months.
Another special circumstance is for children with disabilities. Children with disabilities cannot receive Social Security disability benefits before the age of 18, which means they cannot enroll in Medicare parts A or B until they are 20 years old — unless their disability is ALS.
Is Part B mandatory?
Medicare Part B may seem like it’s mandatory at times, but it’s actually an optional program. However, if you don’t sign up for Medicare Part B when you first become eligible, you will have to pay a late enrollment penalty when you eventually sign up. So while you don’t have to sign up for Medicare Part B when you are first eligible, it may cost you more if you opt out of signing up and then change your mind later.
The late enrollment penalty for Medicare Part B is a 10% increase in your monthly premium for each 12-month period that you were eligible to enroll in Part B but didn’t. This means that the longer you go without signing up for Medicare Part B, the higher your penalty will be. This penalty doesn’t go away, either — it will be added to your monthly Medicare Part B premium for as long as you have Part B coverage.
Below are some examples of penalties you could have to pay if you delay your Part B enrollment:
- The standard monthly Medicare Part B premium in 2022 is $170.10.
- Using this premium rate, if you waited one year to sign up for Medicare Part B, your monthly premium would increase 10%, or by $17.01. Your new Part B premium would be $187.11 per month.
- The premiums for Part B change each year, but assuming the same rate, waiting 5 years to sign up for Part B would result in a penalty of $85.05, bringing your total monthly premium amount to $255.15 per month.
You may be able to avoid a late enrollment penalty if you:
- Are still working and eligible for employer benefits when you turn 65. Once your employment and those benefits end, you have 8 months to sign up for Medicare Part B without a penalty.
- Enroll in Part B past your initial eligibility but you have end-stage renal disease.
What Does Medicare Part B Cover?
Medicare Part B as a whole covers your outpatient care, or care you receive outside of a hospital stay. More specifically, it includes preventive care services and services that are medically necessary to either diagnose or treat a particular condition. Some of the services covered under Medicare Part B include:
- Ambulance services
- Blood transfusions
- Bone density measurements
- Cardiac rehabilitation
- Laboratory testing
- Implantable defibrillators
- Diabetes screenings, education, and supplies
- Doctor’s services
- Durable medical equipment like walkers and blood sugar monitors
- Emergency care
- Home health care services
- Mental health care
- Nutrition therapy
- Occupational therapy
- Outpatient medical and surgical services
- Physical therapy
- Pulmonary rehabilitation
- Routine physicals
- Second opinions for surgical care
- Speech-language pathology
- Telehealth services
- Transplants and immunosuppressive medications associated with them
You also need to be sure that the doctor, facility, or supplier participates in Medicare in order for your services to be covered by the program. If you aren’t sure whether a particular service is covered, you can search for specific items on Medicare’s website.
Are you eligible for cost-saving Medicare subsidies?
Does Social Security Cover Medicare Part B?
The Social Security Administration (SSA) doesn’t cover Medicare, exactly. The SSA helps administer the Medicare program by assisting with enrollment, billing, and information services. Both SSA and Medicare are funded by the federal government through taxes you pay during your working years.
The U.S. Treasury pays for the federal government’s share of your Medicare costs through two trust fund accounts.
- The Hospital Insurance Trust Fund: Medicare Part A and Medicare administration costs
- Supplementary Medical Insurance Trust Fund: Part B and D services, as well as administration costs
Medicare is managed by the Centers for Medicare & Medicaid Services, a division of the U.S. Department of Health and Human Services.
While Medicare isn’t exactly paid for by Social Security, your Medicare Part B monthly premiums are generally deducted from your monthly Social Security payment if there is enough to cover the amount due. You will be billed for any additional premium cost that isn’t covered by your SSA monthly benefit.
Can you get Part B without Social Security?
You don’t have to be receiving Social Security payments to be enrolled in Medicare. You can apply to receive Medicare only through the SSA if you are eligible, even if you aren’t ready to begin receiving your Social Security payments. In this case, however, you will have to pay Medicare directly for your monthly Part B premium.
Is There an Income Limit for Part B?
There is not an income limit for Medicare Part B, but your income will have an impact on what you pay in monthly premiums. More specifically, the earnings you reported two years prior will be used to determine what you pay for your Part B premium. For example, what you pay in 2022 is based on your 2020 income. Monthly premiums are set for certain income ranges.
For single persons, here are the annual income limits and monthly premium amounts for 2022:
- $91,000 or less: $170.10
- Greater than $91,000 to $114,000: $238.10
- Greater than $114,000 to $142,000: $340.20
- Greater than $142,000 to $170,000: $442.30
- Greater than $170,000 to less than $500,000: $544.30
- $500,000 or more: $578.30
For married couples filing jointly, here are the income limits and premium amounts for 2022:
- $182,000 or less: $170.10
- Greater than $182,000 to $228,000: $238.10
- Greater than $228,000 to $284,000: $340.20
- Greater than $284,000 to $340,000: $442.30
- Greater than $340,000 to less than $750,000: $544.30
- $750,000 or more: $578.30
Who’s eligible for free Medicare Part B?
While you may qualify for Medicare Part A if you worked and paid into the Medicare system long enough, this is not the case with Part B. There is almost always a monthly premium charged with Part B, and in most cases it is the standard premium amount ($170.10 per month in 2022.)
If you can’t afford this premium amount, there are a number of programs that can help. Many states offer Medicare Savings Programs that can help you cover the cost of your premium if your income is below a certain threshold, or if you have certain disabilities.
What extra benefits and savings do you qualify for?
How Does Part B Compare to Medicare Advantage?
Medicare Part B and Medicare Advantage (Part C) cover some of the same services, but they are two different programs. Part C includes benefits from Part B.
Medicare Part B is part of Original Medicare, which is made up of Part A to cover inpatient costs. Part B covers outpatient costs. Original Medicare is offered through the federal government and paid in part with your Medicare taxes. You can add prescription coverage — Medicare Part D — separately, but there are some services that will not be covered.
Medicare Advantage plans are private insurance plans that offer at least the same coverage as Original Medicare, but usually a bit more. You can still use your Social Security payments to help pay for part of your Medicare Advantage plan, but these plans may cost more than Original Medicare. The payoff is that many of these plans already include additional services such as prescription drug coverage, hearing, dental, fitness programs, and other services not included in Original Medicare. The additional money you pay up front may even out as you get the services you need without having to enroll in separate policies.