Orlando Harmon
If you have Medicare and other health insurance, such as a group health plan, retiree coverage, or Medicaid, it's important to understand how they work together. Each type of coverage is referred to as a payer. The primary payer covers expenses up to its limits and then forwards the remaining balance to the secondary payer. Medicare Part B, which covers medical insurance, can be the primary or secondary payer depending on the situation. If you have questions about your specific coverage and whether Medicare Part B is credible, it's recommended to contact the Benefits Coordination and Recovery Center or review your plan details.
| Characteristics | Values |
|---|---|
| What is Medicare Part B? | Medical Insurance |
| Who is eligible for Medicare Part B? | Individuals who have earned QCs through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during their working years. |
| What does Medicare Part B cover? | Two types of services: Insulin pumps and insulin through a Medicare Advantage Plan. |
| How much does Medicare Part B cost? | Costs vary based on coverage, services, and providers. |
| How does Medicare Part B work with other insurance? | Medicare Part B can be the primary payer or secondary payer. If it is the secondary payer, you may need to sign up for Medicare Part B before claiming. |
| What is the process for enrolling in Medicare Part B? | Individuals must fill out an application form, such as the CMS 40B. |
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What You'll Learn
Medicare Part B covers medical insurance
Medicare Part B is medical insurance that helps cover two types of services: 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 that prevent illness (e.g. the flu) or detect it in its early stages when treatment is likely to be most effective. Most preventive services are free if provided by a healthcare provider who accepts assignment.
Medicare Part B also covers insulin pumps under its durable medical equipment benefit. If you use an insulin pump, your monthly cost for a month's supply of Part B-covered insulin cannot be more than $35. Similarly, if you get a 3-month supply of Part B-covered insulin, your costs cannot be more than $35 for each month's supply, meaning you'll generally pay no more than $105 for a 3-month supply of covered insulin. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.
Medicare Part B is available as part of Original Medicare, which also includes Medicare Part A (Hospital Insurance). Original Medicare covers things like inpatient hospital care, doctors' services and tests, and preventive services. You pay for services and items as you get them, and you must be lawfully present in the US for Medicare to pay for Part A and Part B-covered services.
You must have both Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage is a Medicare-approved plan offered by a private company that provides an alternative to Original Medicare for health and drug coverage. These "bundled" plans typically include Part A, Part B, and sometimes Part D, which covers prescription drugs.
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Medicare Advantage Plan
A Medicare Advantage Plan is a type of Medicare health plan that provides Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. These plans are offered by private companies that contract with Medicare and are sometimes referred to as "Part C" or "MA plans". To join a Medicare Advantage Plan, you must have both Part A and Part B. Additionally, you may also have other coverage, such as employer or union benefits, military benefits, or veterans' benefits.
When considering a Medicare Advantage Plan, it is advisable to consult with your employer, union, or benefits administrator about their rules, as enrolling in such a plan might result in the loss of your existing coverage. This could also affect the coverage of your spouse and dependents. Additionally, Medicare Advantage Plans have the ability to disenroll members for specific reasons, such as moving outside the plan's service area, losing Medicare or Medicaid eligibility, joining a different drug plan, or if the plan's contract with Medicare ends.
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Medicare Part B deductible
Medicare Part B covers 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 in its early stages.
Medicare Part B also covers most doctor services, including outpatient hospital services, certain home health services, and durable medical equipment. Examples of durable medical equipment include blood sugar monitor test strips, walkers, or wheelchairs.
The standard monthly premium for Medicare Part B enrollees will be $185.00 for 2025, an increase of $10.30 from $174.70 in 2024. The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024. This is the amount you pay for certain medical expenses or prescription drugs before your insurance plan starts paying any of the costs. After the deductible is met, it is typical to pay 20% of the Medicare-approved amount for these services.
Medicare Advantage Plans may have their own deductible, while some may have a $0 deductible. If you are enrolled in a Medicare Advantage Plan, you will only be responsible for paying your Medicare Advantage plan deductible.
Medicare Part D prescription drug plans also have a deductible. The Part D deductible is the amount you pay before your plan helps cover the cost of your prescription drugs. In 2025, no Medicare prescription drug plan can have a deductible of more than $590.
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Insulin pump coverage
Medicare Part B (Medical Insurance) covers two types of services. If you use an insulin pump that is covered under Part B's durable medical equipment benefit, your cost for a month's supply of Part B-covered insulin for your pump cannot be more than $35. This also applies if you get your covered insulin through a Medicare Advantage Plan.
Part B covers durable insulin pumps worn outside the body (externally), including the insulin used with the pump. It does not cover insulin pens or insulin-related supplies like syringes, needles, alcohol swabs, or gauze.
Medicare Part D also includes insulin and certain medical supplies used to inject insulin. Some Part D plans may also cover disposable pump devices that deliver insulin. The cost of a one-month supply of each Part D- and Part B-covered insulin product is limited to $35, and you don’t have to pay a deductible for your insulin. If you get a three-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin product. This means you'll generally pay no more than $105 for a three-month supply of covered insulin.
If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump.
Supplemental coverage can be purchased to help pay your share of costs. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. You must buy this within 6 months of getting Part A and Part B to avoid higher prices or being unable to buy a policy. You may also have other coverage, like employer or union, military, or veterans’ benefits.
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Medicare and other insurance coordination
When an individual has Medicare and other health insurance coverage, each type of coverage is assigned a "payer" role. The "primary payer" pays up to the limits of its coverage and then sends the remaining balance to the "secondary payer." Medicare usually doesn't pay for services provided by a federal healthcare provider or another federal agency. However, TRICARE For Life (TFL) provides expanded coverage for Medicare-eligible uniformed services retirees aged 65 and above, their eligible family members, survivors, and certain former spouses.
The Benefits Coordination & Recovery Center (BCRC) plays a crucial role in coordinating benefits. It collects, manages, and reports information related to coordination of benefits. The BCRC has established agreements with private insurance companies to automatically cross over claims and determine payment responsibilities. Additionally, the BCRC consolidates the Medicare-paid claim crossover process through the COBA program, which sets a national standard for data transmission between the BCRC and other health insurance organisations.
If an individual has Medicare and other insurance coverage, it is important to understand who pays first. In some cases, Medicare may make a conditional payment if the primary payer denies payment, but it will later recover any payments that the primary payer should have made. Individuals are responsible for cooperating with the BCRC, Medicare Advantage, or a Medicare drug plan to verify claims and repay Medicare if necessary.
Supplemental coverage options are available to help pay for an individual's share of costs in Original Medicare. These include Medicare Supplement Insurance (Medigap), coverage from a former employer or union, Medicaid, or private insurance purchased from a company. It is important to note that if an individual does not purchase a Medigap policy within six months of enrolling in Medicare Part A and Part B, they may face difficulties in purchasing a policy or may have to pay higher prices.
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Frequently asked questions
Medicare Part B is Medical Insurance that helps cover two types of services: medically necessary services and preventive services.
Medicare Part B covers medically necessary services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition. It also covers preventive services, such as healthcare to prevent illness or detect it in its early stages.
To get Medicare Part B, you must first be enrolled in Part A. Once you have signed up for both Part A and Part B, you can choose how you want to receive your health coverage. You can either select Original Medicare or Medicare Advantage.
If you have Medicare and other health insurance, each type of coverage is called a "payer." The "primary payer" pays up to the limits of its coverage and then sends the rest of the balance to the "secondary payer." If the "secondary payer" doesn't cover the remaining balance, you may be responsible for the remaining costs.
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