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Medicare Part B: What You Need to Know

What is Medicare Part B coverage?

Medicare Part B covers two key areas of healthcare:

Medically necessary services or supplies that are needed to diagnose or treat your medical condition within accepted standards of medical practice.

Preventive services, which is healthcare you receive to prevent illnesses, like getting a flu shot or having an x-ray to check for pneumonia. You need to receive preventive services from a healthcare provider who “accepts assignment,” so be sure to ask when you make your appointment.

Talk with your healthcare provider or contact Medicare directly to ensure the care you’re receiving is covered by Medicare Part B. SelectQuote, however, can help you see what other options you might have available when it comes to Medicare coverage. There’s no obligation to enroll.

An older woman on a couch stops reading and wonders if she is eligible to receive Medicare Part B coverage

Who is eligible to receive Medicare Part B coverage?

If you have Medicare Eligibility for premium-free Medicare Part A, then you are also eligible for Medicare Part B as long as you enroll and pay your monthly premium on time.

If you are not eligible for premium-free Part A, you may still qualify for Part B if:

  • You’re 65 or older and are a U.S. citizen or a permanent resident lawfully residing in the U.S. for at least five consecutive years.
  • You are younger than 65 with a qualifying disability including end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)—also known as Lou Gehrig’s disease—in which case you will be automatically enrolled in Medicare Part B.
  • You are younger than 65 and receive Social Security or Railroad Retirement Board (RRB) disability benefits, in which case you will be automatically enrolled in Medicare Part A & Part B.
  • You’re 65 or older and are a U.S. citizen or a permanent resident lawfully residing in the U.S. for at least five consecutive years.
  • You are younger than 65 with a qualifying disability including end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)—also known as Lou Gehrig’s disease—in which case you will be automatically enrolled in Medicare Part B.
  • You are younger than 65 and receive Social Security or Railroad Retirement Board (RRB) disability benefits, in which case you will be automatically enrolled in Medicare Part A & Part B.

Do you have to pay a monthly premium for Medicare Part B?

Yes. The standard monthly premium for 2020 is $144.60. However, if your income exceeds a certain amount, you might pay a higher premium known as the Income-Related Adjusted Amount (IRMAA). These amounts may change with each calendar year. Below are the payment amounts based upon your tax return information:

If your yearly income in 2018 (for what you pay in 2020) was
File individual tax returnFile joint tax returnFile married & separate tax returnYou pay each month (in 2020)
$87,000 or less$174,000 or less$87,000 or less$144.60
above $87,000 up to $109,000above $174,000 up to $218,000Not applicable$202.40
above $109,000 up to $136,000above $218,000 up to $272,000Not applicable$289.20
above $136,000 up to $163,000above $272,000 up to $326,000Not applicable$376.00
above $163,000 and less than $500,000above $326,000 and less than $750,000above $87,000 and less than $413,000$462.70
$500,000 or above$750,000 and above$413,000 and above$491.60

Source: https://www.medicare.gov/

Medicare Part B premiums are billed directly to you once a month. However, individuals receiving federal retirement benefits or RRB benefits will see their Medicare Part B premium deducted directly from their monthly benefit check.

Services Medicare Part B Covers

Medicare Part B covers the following:

  • Preventive care and tests
  • Medical services & supplies to treat a health condition
  • Ambulance services
  • Second opinion prior to surgery
  • Durable medical equipment such as a wheelchair or walker
  • Certain outpatient prescription drugs
  • Mental health treatment (in- and outpatient as well as partial hospitalization)
  • Limited rehabilitation services like physical therapy when ordered by your doctor
  • Limited home health care when ordered by your doctor
  • A free one-time preventive visit health assessment which can include flu and hepatitis shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more

Medicare part B does not cover:

  • Part B Premium – The standard Part B premium amount is $144.60 (or higher depending on your income) in 2020.
  • Part B Deductible & Coinsurance – $198 per year in 2020. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy and durable medical equipment.
  • Care received while you’re in the hospital
  • Inpatient care in a skilled nursing facility (but not custodial or long-term care)
  • Hospice care
  • Home health services (within approved limitations)

Enrolling in Medicare Part B

If you already collect Social Security benefits, you’ll be automatically enrolled for Medicare Part B. If you’re over 65 (or turning 65 in the next three months), you need to sign up for Part B (and also Part A)—you will not be automatically enrolled.

We can help you figure out if you’re getting the coverage you need. There’s no obligation to enroll.

Enrollment Periods

Initial Enrollment Period (IEP)

When you first become eligible for Medicare, you have a seven-month Initial Enrollment Period to sign up for Part A that includes the three months prior to your 65th birthday month, your birthday month and the three months following your birthday month.

It’s important to know that if you wait until the month you turn 65 or the three months following, your Part A coverage will be delayed, causing a gap in your coverage. In many cases, if you don’t sign up for Part A when you’re first eligible, you’ll have to pay a late enrollment penalty.

> Learn More About IEP

General Enrollment Period (GEP)

General enrollment for Medicare Part A (and Medicare Part B) takes place January 1–March 31 each year. During this period, you can sign up if:

  • You didn’t sign up when you were first eligible (you may have to pay a late enrollment penalty resulting in a higher premium)
  • You aren’t eligible for a Special Enrollment period

> Learn More About GEP

Special Enrollment Period (SEP)

After your Initial Enrollment Period ends, you may be able to sign up during a SEP and you typically won’t have to pay a late enrollment penalty if you do. You may be eligible if:

  1. You’re covered under a group health plan based on current employment and have a SEP to sign up for Part A and/or Part B anytime as long as:
    • You or your spouse (or family member if you’re disabled) is working
    • You’re covered by a group health plan through the employer or union based on that work
  2. You have an eight-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
    • The month after the employment ends
    • The month after group health plan insurance based on current employment ends
  3. You may qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer, serving in a foreign country

> Learn More About Medicare Enrollment

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