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What is Medicare Part B ?

August 14, 2017

 

What is Medicare Part B?  

Medicare Part B is part of Original Medicare and covers services and supplies that are medically necessary to treat your health conditions. This can include outpatient care, preventive services, ambulance services, and durable medical equipment (DME).  Unlike Medicare Part A, which is premium free for most people, Medicare Part B does require a monthly premium, which is adjusted according to your household income,

and covers up to 80% of your health care costs.  

 

Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (DME), and some preventative services.  Medicare Part B preventive services include:  

  • Abdominal aortic aneurysm screening

  • Alcohol misuse screenings & counseling

  • Bone mass measurements (bone density)

  • Cardiovascular disease and behavioral therapy

  • Cervical & vaginal cancer screening

  • Colorectal cancer screenings

  • Depression screenings

  • Diabetes screenings

  • Diabetes self-management training

  • Glaucoma tests

  • Hepatitis C screening test

  • HIV screening

  • Lung cancer screening

  • Mammogram screening

  • Nutrition therapy services

  • Obesity screenings & counseling

  • One-time “Welcome to Medicare” preventive visit

  • Prostate cancer screenings

  • Sexually transmitted infections screening & counseling

  • Shots: Flu, Hepatitis B, Pneumococcal shots but not Shingles

  • Tobacco use cessation counseling

  • Yearly "Wellness" visit

 

Special Note:  Medicare DOES NOT cover Shingles shots.   

 

For a full list of preventive services covered under Medicare Part B, refer to the Medicare handbook, "Medicare and You."

Eligibility for Medicare Part B

Anyone who is eligible for premium-free Medicare Part A is eligible for Medicare Part B by enrolling and paying a monthly premium. If you are not eligible for premium-free Medicare Part A, you can qualify for Medicare Part B by meeting the following requirements:

  • You must be 65 years or older.

  • You must be a U.S. citizen, or a permanent resident lawfully residing in the U.S for at least five continuous years.

 

You may also qualify for automatic Medicare Part B enrollment through disability. If you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits. You may also be eligible for Medicare Part B enrollment before 65 if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (also known as ALS, or Lou Gehrig's disease).

Medicare Part B premiums

Medicare Part B premiums may change from year to year, and the amount can vary depending on your situation. For many people, the premium is automatically deducted from Social Security benefits.  If you are receiving Social Security, Railroad Retirement Board, or federal retirement benefits, your Part B premium will be deducted directly from your monthly benefit. If not, you will be sent a bill every three months.  

When to enroll in Medicare Part B

Unless you are receiving retirement benefits before age 65 or qualify for Medicare through disability, you will need to sign up for Medicare Part B during your initial enrollment period (IEP). This is the seven-month enrollment period that begins three months before you turn 65, includes the month you turn 65, and ends three months later. Your Medicare coverage start date will depend on which month you signed up during initial enrollment. If you have health coverage through an employer health plan, you may choose to delay enrollment since Medicare Part B comes with a monthly premium.  If you delay your Part B you will have an eight month special enrollment period (SEP), once you retire, to sign up and to choose a Medigap plan to supplement the gaps that Parts A & B do not cover

 

If you do not enroll during your initial enrollment period (IEP) and do not qualify for a special enrollment period (SEP), you can also sign up during the Part B general enrollment period (GEP), which runs from January 1 to March 30. You may have to pay a late enrollment penalty (LEP) for not signing up when you were first eligible, and your Part B coverage will not be effective until July of that year.  Your monthly premium may be 10% higher for each 12-month