Medicare Part B

What does Medicare Part B cover?

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Medicare Part B throughout the United States.

What you need to know about Medicare Part B insurance benefits.

What Does Medicare Part B Cover?

Medicare Part B covers your Doctors visits for you.

Medicare Part B (Medical Insurance) helps cover:

  • Services from doctors and other health care providers, such as inpatient medical and surgical services and supplies, physical, speech and occupational therapy.
  • Hospital outpatient care, such as outpatient medical and surgical supplies and services.
  • Home health care
  • Durable medical equipment, such as wheelchairs and walkers.
  • Preventative services, such as clinical laboratory and diagnostic services.

Like Part A, eligibility for Medicare Part B starts the first day of the month in which you turn 65.

If an individual is currently collecting Social Security benefits, the Social Security Administration assumes that they are choosing to enroll in Medicare Part B by default.

In many situations however this may not be the case. Individuals may still be working and covered under their employer’s health plan, or they may be covered under a spouse’s plan. In this case, they can elect to contact Social Security and temporarily dis-enroll from Medicare Part B.

How Much Does Medicare Part B Cost?

The 2019 standard monthly premium for Medicare Part B will be $135.50. This is an increase of only $1.50 from $134 in 2018.

You’ll pay a different premium amount if:

  • You enroll in Part B for the first time in 2018
  • You don’t get Social Security benefits
  • You’re directly billed for your Part B premiums
  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard amount of $134.00)
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount

Medicare Premiums Chart for 2018

Medicare Part B

How Much is the Medicare Part B Deductible?

The 2019 annual deductible for all Medicare Part B beneficiaries will be $185. This is an increase of $2 from the annual deductible $183 in 2018.

Traditionally, once the deductible is met, Medicare pays 80% of the Part B expenses and the beneficiary is responsible for the remaining 20%.

Unfortunately, there is NO OUT-OF-POCKET MAXIMUM with traditional Medicare Part A and Part B.

This means beneficiaries that are ONLY enrolled in traditional Medicare are left open to catastrophic, unlimited costs if they do not have any secondary coverage. e.g. a Medicare Supplement, a Medicare Advantage Plan or are dual-eligible and receive Medicaid.

For example, someone is diagnosed with pancreatic cancer having to undergo multiple chemotherapy treatments would only have 80% of their out-of- pocket costs covered with Part B. The Medicare beneficiary would in turn be responsible for the remaining 20%, which could run in to tens-of-thousands of dollars.

When to Enroll in Medicare Part B?

When individual’s turns 65 and they have elected to begin to collect Social Security benefits, the Center for Medicare Services (CMS) assumes an individual wished to enroll in Medicare Part B.

Consequently, when CMS sends the individual his or her new Medicare card it will show an effective date for Medicare Part B that matches the effective date for Medicare Part A.

If the individual chooses not to collect Social Security when they turn 65, the Social Security Administration assumes the individual does not wish to have Medicare Part B take effect either.

This is because Social Security assumes the newly eligible Medicare individual is still working and receiving health insurance from his or her employer.

It is important to be aware of these assumptions to ensure that the correct enrollment choices are made.

Contact your local Social Security office, visit www.ssa.gov or call (800) 772-1213 to ensure you advise Social Security when you want each of your benefits to begin. To enroll in Medicare, click here.

Special Enrollment Periods (SEP) For Medicare Part B

Typically, Special Enrollment Periods (SEP) occur when an individual has a qualifying event occur that makes them eligible outside of the normal enrollment at age 65.

A qualifying event is an event such as losing or opting out of an employer’s health insurance plan. If an individual is covered under an employer health insurance plan, they may not elect to wait to enroll in Medicare Part B. When their coverage stops, they become eligible to enroll in Medicare Part B during a Special Enrollment Period.

If an individual does not elect Medicare Part B when they are first eligible and does not have credible coverage elsewhere, they can only enroll in Medicare Part B between January and March of each year. Their coverage will take effect the following July 1.

Additionally, Medicare may assess a late enrollment penalty if an individual did not enroll when they were eligible for Medicare Part B and did not have other credible coverage.

For more information on Medicare Part B, contact us today.

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