Jane Dotson
Medicare Part B is optional medical insurance that helps cover medically necessary services and preventive services. It is available to individuals who are eligible for premium-free Part A or pay a premium for this coverage. Most people get Part A for free, but some have to pay a premium. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty. You can also choose to have both Medicare Part B and employer insurance, or delay enrolling in Part B if you have employer insurance.
| Characteristics | Values |
|---|---|
| What is Part B? | Medicare Part B (Medical Insurance) |
| Who is it for? | Individuals who are not eligible to get Medicare Part A for free |
| What does it cover? | Doctors' services, outpatient care, and other medical services that Part A doesn't cover. It also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. |
| Cost | Monthly premium. The standard premium amount is paid by most people. |
| Late enrollment | If you don't sign up for Part B at age 65 when you become eligible, you will pay a late enrollment penalty. |
| Late enrollment penalty | 10% above the standard premium cost for every 12-month period delayed. |
| Enrollment | To sign up for Part B, you need to contact the SSA. |
| Enrollment form | CMS-40B |
| Special Enrollment Period | Individuals who were performing volunteer service outside of the US for at least 12 months and had health insurance during that time may enroll using this SEP. |
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What You'll Learn
- Medicare Part B covers doctors' services, outpatient care and other medical services
- Part B is optional and has a monthly premium cost
- You can choose to have both Part B and employer insurance
- You can apply for Part B during a Special Enrollment Period
- Part B covers some prescription drugs but not pharmacy-bought ones
Medicare Part B covers doctors' services, outpatient care and other medical services
Medicare Part B is a government-funded insurance program that covers medically-necessary services like doctors' services, outpatient care, and other medical services. It is optional and has a monthly premium that most people pay. If you have Part A, you can add Part B during specific enrollment periods. Your coverage generally begins the first day of the month after you sign up, and you can avoid late enrollment penalties by signing up promptly.
Part B covers doctor visits, diagnostic tests, and screenings. It also includes preventive care, such as exams, lab tests, and screening shots to help prevent, detect, or manage a medical problem early. For example, Part B covers diagnostic bone density screenings, as well as tests for diabetes, glaucoma, and breast cancer. It also covers mental health services, including visits to a psychiatrist or nurse practitioner.
Medicare Part B generally covers outpatient care, or care received in a doctor's office or clinic rather than a hospital. It covers 80% of the Medicare-approved costs of certain services, and most of these services are administered on an outpatient basis. Part B also covers emergency room visits and services received there, even if the patient is later admitted to the hospital.
Part B also covers some home health services, durable medical equipment, and physical therapy. However, it does not cover inpatient hospital services or most prescription medications. In 2020, it began covering acupuncture for lower back pain for the first time. It is important to note that Medicare regularly evaluates which services Part B will cover, and some services may not be covered.
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Part B is optional and has a monthly premium cost
Medicare Part B is optional and has a monthly premium cost. It covers medically necessary services, such as doctors' services, outpatient care, and other medical services that Part A doesn't cover. It also covers preventive services like exams, lab tests, and screening shots to help prevent, detect, or manage a medical problem. Most people get Part A for free, but some have to pay a premium. If you decide to enrol in Part B, you will need to pay a monthly premium. The standard premium amount is the most common, but this can vary depending on your income.
You can choose to have both Medicare Part B and employer insurance, or you can delay enrolling in Part B if you have employer insurance. If you are covered by employer-sponsored insurance (either yours or your spouse's) from a company with 20 or more employees, you won't need to pay the Part B late enrollment penalty. In that case, you don't have to do anything when you turn 65 unless you are already receiving Social Security or Railroad Retirement Board benefits. If you decide to stick with employer-sponsored coverage without signing up for Medicare Part B, make sure you know when your coverage will end, as you will need to take action at that time.
If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty. This penalty is an extra 10% above the standard premium cost for every 12-month period you delayed. This late enrollment penalty is permanent and must be paid for as long as you have Part B. To avoid this, it is recommended to sign up for Part B during your initial enrollment period around your 65th birthday. However, there are certain situations that qualify for a Special Enrollment Period, which allows you to sign up without penalties. For example, if you've been covered by an active employer group health plan since turning 65, you can enrol in Part B during a Special Enrollment Period of up to eight months after your coverage ends, without incurring a penalty.
If you want to enrol in Part B, you will need to fill out the Application for Enrollment in Medicare Part B (CMS-40B) and contact the SSA to find the best way to sign up based on your situation.
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You can choose to have both Part B and employer insurance
Medicare Part B is optional and helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. It also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. Most people pay a monthly premium for Part B. If you already have Part A, you can add Part B during specific enrollment periods.
If you have employer insurance and Medicare Part B, you can delay enrolling in Part B without penalties as long as your employer insurance qualifies as "creditable coverage". This means it provides benefits that are at least as good as those offered by Medicare. Once you lose your employer coverage, you can enroll in Part B during a Special Enrollment Period without late enrollment penalties.
If you have both Medicare and employer coverage, they will need to coordinate benefits. This means that either Medicare or the employer plan pays first for covered care, and the other insurance is "secondary" and may also pay a portion of the costs. This is called "coordination of benefits". It is important to note that if your group health plan or retiree coverage is the secondary payer, you may need to sign up for Part B before they pay.
If you decide to have both Medicare and employer coverage, you may want to consider signing up for prescription drug coverage under Medicare Part D. Additionally, Medicare Supplement Insurance can help pay the out-of-pocket costs of Medicare Part A and Part B.
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You can apply for Part B during a Special Enrollment Period
Part B of Medicare is optional and helps cover medically necessary services and supplies, as well as preventive services. If you already have Part A, you can add Part B during specific enrollment periods. You can apply for Part B during a Special Enrollment Period (SEP) if you meet certain criteria.
For example, if you or your spouse are over 65 and still working, and you are covered under a group health plan based on that current employment, you may not need to apply for Part B at 65. You may qualify for an SEP that will let you sign up for Part B during any month you remain covered under the group health plan and your, or your spouse's, current employment continues. Alternatively, you can sign up during the eight-month period that begins with the month after your group health plan coverage or the current employment it is based on ends, whichever comes first.
You may also qualify for an SEP if you lose health coverage through your employer or a family member's employer, including if you lose coverage as a dependent. You may also qualify if you lose individual health coverage, such as if your plan is discontinued, you lose eligibility for a student health plan, or you move outside of your plan's service area.
To apply during an SEP, you may need to fill out additional forms, such as the Request for Employment Information (CMS-L564) or the Application for Medicare Part A and B - Special Enrollment Period (Exceptional Conditions) (CMS-10797).
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Part B covers some prescription drugs but not pharmacy-bought ones
Medicare Part B is optional and helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, detect, or manage a medical problem. Part B covers some prescription drugs, but not all, and it's important to understand the scope of this coverage.
Part B covers certain prescription drugs in specific circumstances, and these may include drugs administered in a doctor's office, hospital outpatient setting, or pharmacy. For instance, it covers calcimimetic medications under the ESRD payment system, including intravenous medication Parsabiv and oral medication Sensipar. It also covers oral anti-nausea drugs that are part of an anti-cancer chemotherapeutic regimen if taken before, during, or within 48 hours of chemotherapy. Additionally, Part B covers intravenous immune globulin (IVIG) for those diagnosed with primary immune deficiency disease and who meet certain medical criteria.
It's important to note that Part B does not cover all prescription drugs, and some drugs are specifically excluded from its coverage. For example, Part B does not cover "self-administered drugs" in a hospital outpatient setting. These are drugs that individuals would typically take on their own. If you obtain non-covered prescription drugs in a hospital outpatient setting, you will be responsible for the full cost of the drugs unless you have alternative drug coverage.
To ensure you understand your coverage, it is recommended to review your plan's drug list or formulary, as different plans may have varying rules and coverages. If you have Original Medicare, you can enrol in a Medicare drug plan (Part D) to obtain Medicare drug coverage for drugs filled at a pharmacy. This additional coverage can help ensure you have the necessary medications, especially if you require medications not covered by Part B.
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Frequently asked questions
Part B medical insurance, also known as Medicare Part B, helps cover medically necessary services and preventive services. Medically necessary services are services or supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. Preventive services are healthcare services to prevent illness or detect it at an early stage.
Part B medical insurance is optional. However, if you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. However, if you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty, which is an extra 10% above the standard premium cost for every 12-month period you delayed.
To sign up for Part B, you'll need to contact the Social Security Administration (SSA). You can apply online or by filling out the Application for Enrollment in Medicare Part B (CMS-40B) form and submitting it to your local Social Security office.
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