Medicare Part B is known as medical insurance and is another half of Original Medicare, a national health care program managed by the federal government. It covers annual wellness visits, laboratory tests, bloodwork, x-rays, medical equipment, mental healthcare, and ambulance services. Under Part B insurance, in most cases, you will pay 20% of the Medicare-approved amount for each item or medical service. It does not cover DHV (dental, hearing, and vision) exams, hearing aids or glasses, emergency assistance outside the U.S., long-term care, and Prescription drug coverage. Medicare Part B requires you to pay a monthly premium.
MEDICARE PART B COVERAGE
Medicare Part B in general covers, but is not limited to, next outpatient services:
- Visits to the doctor`s office
- Preventive care
- Physical therapy
- Flu shots
- Pneumococcal shots
- Outpatient mental health care
- Diabetes screenings, supplies, and self-management therapy
- Durable Medical equipment
- Alcoholism counseling
- Some dermatological services (if medically necessary)
WHAT DOES MEDICARE PART B NOT COVER?
There are some health care services that Part B does not cover, but Medicare Advantage (Part C) plans do, including:
- Long-term care
- Prescription drug plan
- Routine hearing, dental and vision exams
- Fitness club membership
- Hearing aids or glasses
- Emergency assistance outside the U.S.
MEDICARE PART B COSTS
Medicare Part B requires you to pay a monthly premium based on your adjusted gross income and a yearly deductible before coverage begins. Your costs if you enroll in Medicare Part B will include Part B monthly premium, coinsurance (part of the cost that Medicare does not pay), and a yearly deductible. The standard monthly fee for Part B is $164.90 in 2023. It is higher for recipients who have higher incomes. The annual deductible for Part B is $226 in 2023. In addition, the patient pays 20% of the bill as a coinsurance payment.
PART B ELIGIBILITY
Eligibility for Part B has the same rules as Medicare Part A. Primary criteria is that you must be age 65 or older and a U.S. citizen. Legal and permanent residents of the United States for at least 5 years in a row can also qualify for Part B. Finally, you can apply for it if you have been diagnosed with End-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). A person under the age of 65 with certain disabilities that harden normal life and requires high care and attention can apply as well.
MEDICARE PART B ENROLLMENT
All Medicare Part A beneficiaries are also entitled to enroll in Part B. An aged person not entitled to Part A may enroll in Part B if is 65 years old or over and is either a U.S. citizen or lawfully admitted for permanent residence who has resided in the United States continuously for 5 years in a row. A person who is automatically enrolled in Medicare Part A is also automatically enrolled in Part B. However, because beneficiaries are obligated to pay a Part B premium, they have the option of turning down the enrollment for it.
If you have health insurance through your employer of more than 20 people, you qualify for a Special enrollment period. This Special enrollment period allows you to enroll once you lose the coverage or are no longer employed. If you enroll during the eight months of your Special enrollment period, you do not have to pay a late enrollment penalty.
LATE ENROLLMENT FEES
Medicare Part B’s late enrollment penalty adds 10% of the standard premium rate for each 12-month period you went through without signing up. This lasts as long as you hold Part B coverage. The standard premium rate for Part B in 2023 is $164.90. So, if you enrolled in Part B two years later, your monthly premium will be bigger by 20%, and in this case, the late enrollment penalty fee would be $33 per month ($164.90 divided by 10 gives a late enrollment penalty fee for a 12-month period, and then multiply it with the number of years you missed to enroll). So in case of enrollment two years later, your monthly premium would be $197.90 ($164.90 + $33) for as long as you have Part B coverage.