Individual And Group Benefit Solutions

Medicare Part B Explained

Medicare Part B generally covers Medical Expenses

Explaining Medicare Part B starts with knowing what it covers. Medicare Part B covers things like: doctors visits, tests, diagnostic procedures, and x-rays. Part B medications area also covered (prescription medication administered in a doctors office).  Additionally, durable medical equipment  falls under Medicare Part B.  Note: this is not an exhaustive list of items covered.

It’s also important to know what Medicare Part A and B doesn’t cover.

The following are not covered: most dental work, prescriptions picked up at your local pharmacy, Vision services (except Cataract removal and treatment of Glaucoma), Long-Term Care services, vitamins, over the counter items, and elective or non-medical services.  Note: this is not an exhaustive list of items not-covered.

When do you enroll? 

You will generally want to enroll in Medicare Part B during your initial enrollment period.  The initial enrollment period is a 7 month window that begins 3 months before you’re 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 your 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 the standard premiums for 2022 is  $170.10 a month.

Low income individual may qualify for Medicaid, and Medicaid would pay for your monthly Medicare Part B premiums.

If your income exceeds $91,000 individually or $182,000 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.

Chart for cost of Medicare Part B for high income earners

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.

How much does Medicare Part B cover?

Part B Services 2022You 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 $233 of Medicare-approved amounts *$233
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.

There is no maximum out-of-pocket expenses with Original Medicare!

However there are a couple things you can do to eliminate or reduce your out-of-pocket Medicare Expenses

Link to Medicare Part A Explained
Link to Medicare Supplement information