Individual And Group Benefit Solutions

Medicare Part B

MAPD and PDP Plans

Medicare Part B generally covers Medical Expenses

(see chart below)

When do you enroll? 

You will typically want to enroll in Medicare Part B during your initial enrollment period.  Your initial enrollment period is a 7 month window at the time you are first eligible for Medicare (Either the month you turn 65 or the 25th month of disability).

Example:  Mary turns 65 on July 15th, 2014 she is eligible to enroll in Medicare Parts A,B,C, and D from April 2014 till October 2014.

Note: It is important to understand when Mary’s coverage will start!  If you sign up for Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) during the first 3 months of your Initial Enrollment Period, your coverage starts the first day of your birthday month, unless your birthday is on the first day of the month.

Example 1:

If Mary’s birthday was September 2nd and she signed up in June her Coverage would start on September 1st.

Example 2:

If Mary’s birthday was September 1st and she signed up in June her Coverage would start on August 1st.

What does it cost?

The cost for Medicare Part B depends on your income level.

For individuals NOT on public assistance (Medi-Cal or Medicaid)  and earning less than $85,000 or $170,000 jointly your premiums for 2017 is the standard rate $134 a month.

If your income exceeds $85,000 individually or $170,000 jointly you’ll have to pay an additional  amount called the income-related monthly adjustment amount.  See The Guide to Medicare For High Income Earners for details

If your income is very low and you qualify for Medicaid you may not pay anything.

How do I enroll in Medicare PART A and/or PART B?

If you are currently receiving Social Security Income or Railroad Retirement Income you will likely not need to do anything and will be automatically enrolled when you turn 65 or are in your 25th month of disability.  However, if you are not receiving either of the previously mentioned funds you will need to contact Social Security via phone, in-person, or online.  To enroll online visit the Social Security website

IMPORTANT NOTE: Not enrolling in Medicare when you are first eligible will likely result in a permanent penalty and a serious lapse in coverage.  If you have already missed your initial enrollment period we can help you minimize the penalty and get temporary health coverage.

Okay, I’ve been enroll in PART A and PART B now what?

If you stop with just PART A and PART B coverage you will be responsible for:

  • Part A and Part B deductibles

  • Part A and Part B co-insurance and co-pays

  • 100% of the cost of your prescription and drug costs (a few exceptions for hospital settings and Dr’s office)

The out of pocket cost to you could be unlimited if you stopped here, but fortunately you have options:

  1. Enroll in a Medicare Supplement Plan

  2. Enroll in a Medicare Advantage Plan (MA or MAPD)

  3. Enroll in a Medicare Prescription Drug Plan (PDP)


As you can see Medicare Part A covers a lot, but there are still gaps that you are responsible for.

MAPD and PDP Plans

Current Medicare Part B information for year 2017

* Part B has a $183.00 deductible per year

Part B Services 2017 Medicare Pays
MEDICAL EXPENSES –  In or out of the hospital and outpatient hospital treatment, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment
First $183 of Medicare-approved amounts * $0
Remainder of Medicare-approved amounts Generally 80%
Part B Excess Charges (above Medicare-approved amounts) $0
First 3 Pints $0
Remainder after $183 deductible* 80%
Clinical Lab Services – Tests for Diagnostic Services 100%
PARTS A&B 100%
HOME HEALTH CARE – Medicare-Approved Services
Medically necessary skilled care services and medical supplies 100%
DURABLE MEDICAL EQUIPMENT – Medicare-approved amounts after $183.00* deductible 80%
* Once you have been billed $183 of Medicare-approved amounts for covered services (which are noted with asterisk), your Part B deductible will have been met for the calendar year.

Medicare Part B covered services