Medicare Part B

Acknowledge the Significance of Medicare Part B, with Health Insurance Expert, InsureMeNow

Medicare Part B Insurance Plans

Medicare Part B is a part of original Medicare that covers medical services and supplies that are medically essential to treat your health condition. This plan is designed to help you pay for most of your non-hospital related medical coverage. Medicare Part B is designed to fill some of the gaps of Part A medical insurance coverage. The Part B pays 80% of the reasonable charge for covered services of the reimbursement rate determined by Medicare after you pay the annual deductible. The reasonable charge is less than the provider’s actual charge. If the healthcare provider accepts the Medicare assignment then he agrees to accept Medicare reasonable charge as full payment and the patient is responsible for paying only the remaining 20%. Though it is optional, Part B is the coverage that helps you avoid paying 100% of your doctor visits. Besides doctor visits, Part B also covers physical, speech and occupational therapy, second opinions, certain drugs administered by doctor and some medical equipment like wheelchairs, canes, scooters etc. Along with monthly premium, you still have out of pocket costs.

Part B Coverage

Generally Medicare Part B covers necessary medical services and supplies that are essential for diagnosing and treating a medical condition. Generally Medicare Part B Coverage Include:

  1. Doctor Visits
  2. Outpatient Care
  3. Home health Care
  4. Durable Medical Equipment
  5. Preventative Care

It also covers certain types of preventive care and the preventive services such as:

  1. Alcohol misuse screenings
  2. Bone density measurements
  3. Cardiovascular disease screenings
  4. Mammograms
  5. Cervical, colorectal, and prostate cancer screenings
  6. Diabetes screenings
  7. Depression screenings
  8. Flu shots
  9. Glaucoma tests
  10. Pneumococcal shot
  11. Yearly wellness visit

Eligibility for Medicare Part B

If you are eligible for premium free Medicare Part A then you are also eligible for Medicare Part B. However you need to enroll and pay a monthly premium for Part B coverage. In case if you are not eligible for premium free Medicare Part A, then you can qualify for Medicare Part B by fulfilling the following requirements:

  • You should be 65 years of age or older
  • You should be a U.S. citizen or a permanent resident lawfully residing in the U.S for at least five continuous years.
  • If you are under 65 and receiving Social Security or Railroad Retirement Board disability benefits then you
  • will be automatically enrolled in medicare Part A and Part B after 24 months of disability benefits.
  • You will become eligible for Medicare Part B before 65 if you have end-stage renal disease or amyotrophic
  • lateral sclerosis.

Medicare Part B Deductible and Coinsurance Amounts

The annual deductible for Medicare Part B is $185 in 2019 and you also need to pay a 20% coinsurance for many covered services. If your health care provider accepts assignment for a covered service, then you will need to pay the Part B deductible along with 20% of the medicare-approved amount for the availed medical services. Doctors by accepting the medicare Part B assignment cannot charge you more than the Medicare approved amount for the covered services and you will be responsible for sharing the cost. Home Health Services are covered completely at no cost but if you need durable medical equipment then you will need to pay 20% of the cost.

Medicare Part B Costs and Payments

In order to avail the Medicare Part B benefits you need to pay a monthly premium. However, a standard monthly amount is set by the government and in the current year that is 2019, the base rate for Part B is $135.5 per month for new medicare applicants. Though, the premium amount can exceed if your income is above a certain level. It is important to know that you should not miss your enrollment window whenever you retire or lose access to your employer group health insurance because if you enroll late in Part B then you have to pay a penalty for life. Part B premium is deducted by Medicare from your Social Security check if you are enrolled in your Social Security income benefits and if you are not enrolled then they will bill you quarterly. Medicare also provides a credit card option at the bottom of the quarterly invoices. You just need to complete the bottom portion of the payment coupon and mail it to the Medicare premium collection center to pay the premium by credit card. You can also pay the premium using Medicare Easy Pay option, which is a free auto draft service that automatically deduct the premium amount from your checking or savings account.

Different Enrollment Period for Medicare Part B

If you are planning to enroll in Medicare Part B then you can enroll in the plan during any of the below given period.

Initial Enrollment Period – It is the seven-month time-frame, which starts three months before the month you are eligible to receive Medicare. If you qualify for Medicare because of disability your Initial Enrollment Period starts three months before your 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts for up to seven months.

General Enrollment Period – In case if you missed your Initial Enrollment Period, then you can enroll in Part B during the General Enrollment Period that starts every year from January 1 and ends on March 31. If you enroll during General Enrollment Period your coverage will go into effect on July 1 of the year that you signed up.

Special Enrollment Period – If you or your spouse are working and have group health coverage based on current employment then you may opt to delay your Medicare Part B enrollment. On retirement you will lose your group health coverage and then you are given a Special Enrollment Period during which you can enroll in Part B. It is the eight month period following the month in which the employer coverage ends or you stop working, whichever happens first.

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