Individual And Group Benefit Solutions

Medicare Part B

Medicare Part B generally covers Medical Expenses

See the Medicare Part B Chart below for your deductible and co-insurance amounts.  A description of Medical expenses according to Medicare are things like: Doctors visits, test, diagnostic procedures, x-rays and more

When do you enroll? 

You will typically want to enroll in Medicare Part B during your initial enrollment period.  The 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.

Important:

It’s critical 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.

How much does Part B 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 $87,000 or $174,000 jointly your premiums for 2020 is the standard rate $144.60 a month.

If your income exceeds $87,000 individually or $174,000 jointly you’ll have to pay an additional  amount called the income-related monthly adjustment amount.  The amount is determined by your MAGI or Modified Adjusted Gross income from 2 years ago.

2020 Medicare chart for high income earners

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 https://www.ssa.gov/medicare/

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.

You’ve enrolled in PART A and PART B here’s what to expect:

Deductible and Co-insurance with Part B coverage

* Part B has a $198 annual deductible in 2020

Part B Services 2020You pay
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 $198 of Medicare-approved amounts *$198
Remainder of Medicare-approved amounts20%
Part B Excess Charges (above Medicare-approved amounts)100%
Blood
First 3 Pints100%
Remainder after $198 deductible*20%
Clinical Lab Services – Tests for Diagnostic Services0%
PARTS A&B0%
HOME HEALTH CARE – Medicare-Approved Services
Medically necessary skilled care services and medical supplies 0%
DURABLE MEDICAL EQUIPMENT – Medicare-approved amounts after $198.00* deductible20%
* Once you have been billed $198 of Medicare-approved amounts for covered services (which are noted with asterisk), your Part B deductible will have been met for the calendar year.

If you stop with PART A and PART B Medicare 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 (few exceptions for hospital settings and Dr’s office)

There’s no Maximum out of Pocket with original Medicare Parts A and B

A couple ways to eliminate or reduce your Medicare expenses:

  • Enroll in a Medicare Supplement Plan

  • Enroll in a Medicare Advantage Plan (MA or MAPD)

  • Enroll in a Medicare Prescription Drug Plan (PDP)

 

 
 
MAPD and PDP Plans