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Medicare Part B

Medicare Part B covers medically necessary services and preventative services. It makes up one half of Original Medicare.

What is Medicare Part B?

Medicare Part B is one half of Original Medicare, with Part A making up the other half. It offers coverage for a few main categories of services.

First off, it covers medically necessary services. These are services required to diagnose and treat your condition. It also covers preventative services like flu shots or early illness detection when deemed the best option. Finally, it covers certain home health services

Some of the factors that determine whether a service or treatment is deemed medically necessary and eligible for coverage under Medicare Part B include federal and state laws. Medicare itself sometimes weighs in on certain coverage decisions, especially for treatments that might seem to be potentially cosmetic in nature. Finally, private insurance companies may also play a role in determining whether a specific treatment is necessary on certain types of plans.

What does Medicare Part B cover?

Part B medical insurance covers a number of outpatient services, preventative services, and more.

  • Ambulance Services: Part B covers ground ambulance transportation for medically necessary purposes. It may also pay for some non-emergency ambulance services if you have a written order from your doctor stating that the service is medically necessary. 
  • Doctor’s Services: Medicare Part B covers most doctor’s visits, along with an Annual Wellness Visit. Additionally, Part B covers treatments like surgery, radiation and chemotherapy treatments, and dialysis.  
  • Outpatient Care: Part B benefits also include outpatient services that don’t require admission to a hospital. Some examples include emergency room charges and medically necessary treatments (X-rays, injections, etc.)
  • Home Health Care: Though also covered under Medicare Part A, Part B covers some occasional or part-time home health care services. 
  • Mental Health Care: Mental health care also falls under Part B coverage. This includes partial hospitalization, which acts as an alternative to inpatient psychiatric care. Benefits also include outpatient mental health services, such as annual depression screenings, individual and group psychotherapy, family counseling, psychiatric evaluations, and diagnostic tests.
  • Clinical Laboratory Services: Clinical laboratory services are another element of Part B health insurance. This entails laboratory work and diagnostic tests (bloodwork, urinalysis, screenings, etc.). 
  • Medically Necessary Equipment: Certain medically necessary equipment is also covered under Part B. This medical equipment includes, but is not limited to, blood sugar meters, canes, crutches, hospital beds, nebulizer equipment, oxygen machines, patient lifts, walkers, and wheelchairs. 
  • Certain Prescription Drug Coverage: Limited outpatient prescription drugs fall under Part B coverage. These include drugs infused through medically necessary equipment (like a nebulizer), other injectable and infused drugs, some antigens, injectable osteoporosis drugs, and ESRD medication. However, for most drugs, you must get separate prescription drug coverage through Medicare Part D if you want help paying for your prescription medications.
  • Preventative Services: Part B covers preventative services, such as screenings and certain shots. This area of coverage entails preventative screenings, like cancer or diabetes screenings, and preventative shots, like flu vaccinations, Hepatitis B shots, and pneumococcal shots.  

How much does Medicare Part B cost?

Medicare coverage certainly helps when it comes to covering your health care expenses, but it comes with certain related costs that you should be aware of.

Part B Monthly Premium

The standard Part B monthly premium in 2021 is $148.50/month. Most people pay this monthly premium, though what you pay depends on your income. If you made $88,000 or less in 2019 (or $176,000 joint filing), you are eligible for the standard premium amount in 2021. 

However, as your income goes up, you may have to pay an extra charge on top of your Part B monthly premium. This is called the Income Related Monthly Adjustment Amount (IRMAA). In this case, your premium increases incrementally and caps off at $504.90 for those earning more than $500,000 ($750,000 joint filing) annually. 

If you receive Social Security benefits, your Part B premium may be deducted from your monthly social security check. If this doesn’t happen, you will be billed quarterly, and you will have the option to pay with a credit card.

Part B Deductible and Coinsurance

Medicare Part B also has a $203 deductible. After meeting your deductible, you pay 20% of the Medicare-approved amount for most doctor’s services, outpatient therapy, and durable medical equipment. This 20% fee is referred to as your Part B coinsurance.

If you would like help paying for your Part B coinsurance, consider enrolling in a Medigap plan, which can help to pay for your out-of-pocket Medicare costs, including copayments and coinsurance. Reach out to us today for a free Medicare consultation to explore your coverage options.

Medicare Part B Eligibility

If you are eligible for Medicare premium-free Part A, you are likely also eligible for Part B. You can enroll in Medicare Part B once you qualify for Part A.

If you are already receiving Social Security or RRB benefits at least four months before you are eligible for Medicare, you will be automatically enrolled in Part B, along with premium-free Part A. Additionally, people who have been receiving disability benefits for 24 months or suffer from End-Stage Renal Disease (ESRD) or ALS can also enroll in Medicare Part B.

You can choose whether or not you want to keep Part B, but in some cases, if you don’t sign up for coverage when you are first eligible (during your Initial Enrollment Period), you may have to pay a late enrollment penalty fee. You have to pay this on top of your premiums if you eventually decide to enroll in Part B. 

If you pay for Medicare premium Part A, you may also be eligible for Part B. In this case, you must be 65 years of age or older. Additionally, you must be either a U.S. citizen or lawful permanent resident who has lived in the United States for five continuous years.

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