Medicare Part B

Medicare Part B is medical insurance that covers doctor and outpatient services.  Part B also covers medical supplies, home health care and preventive services.  You have to pay a $170.10 every month to receive Part B.  In contrast, Part A (hospital insurance) is free to most people.

Medicare Part B Overview

Part B is half of “Original Medicare” (Part A is the other half) and came into existence in 1965.  In contrast, Medicare Part C (Medicare Advantage) and Part D (prescription drug coverage) aren’t considered part of Original Medicare because they were formed after 1965.

Medicare Part B covers…

• physician services
• hospital outpatient services
• most physician services while you’re a hospital inpatient
• durable medical equipment
• some home health care
• preventive services
• some outpatient prescription drugs
• miscellaneous medical and health services not covered by Part A

Physician services are more than just care from your primary care provider.  For example, Part B covers services from physical therapists, clinical psychologists, nurse practitioners, occupational therapists and physician assistants.  In addition, care from a dentist, eye doctor and chiropractor are covered in special circumstances.

Part B does NOT cover…

• dental, vision and hearing (see exceptions below)
• long term care
• cosmetic surgery
• acupuncture
• routine foot care

Part B doesn’t cover things like dental exams, fillings, eye glasses, contacts and hearing aids.  However, if an accident or illness causes an injury to your teeth, eyes or ears then Part B will cover the required medical procedure.  You will need to purchase a separate insurance policy that covers your routine dental, vision and hearing needs.

How do I get Part B?

You will be automatically enrolled in Part B if you are receiving Social Security at least four months before turning 65.  However, if you aren’t receiving Social Security benefits before turning 65 you will have to enroll yourself.  The best time to enroll in Part B is during your Initial Election Period (IEP).  Your IEP lasts for 7 months.  It begins 3 months before your 65th birthday month and ends 3 months after your birthday month.  For example, if you turn 65 in July, your IEP begins April 1 and ends October 31.

When will my Part B coverage start?

The short answer is…it depends.  Let’s use the above example of turning 65 in July for the following scenarios:

• You enroll in Part B during the April – June time period.  Your coverage will start on July 1.  This is your best case scenario.
• You enroll in Part B in July.  Your coverage will begin August 1.
• You enroll in Part B in August, one month after you turn 65.  Your coverage will start two months later, on October 1.
• You enroll in Part B in September or October, which is two or three months after you turn 65.  Your coverage will start three months later, on December or January 1 respectively.

How do I enroll in Medicare Part B?

You can enroll in three ways:

• Call Social Security at 1-800-772-1213
• Visit your local Social Security office
• Apply online

Finally, there is one other way to enroll in Part B.  You may already have Part A and delayed enrollment in Part B because you had employer health insurance.  If so, you can fill out form CMS 40B, Application for Enrollment in Medicare – Part B.  You will be enrolling in a Special Enrollment Period (SEP) and will need to prove you had creditable coverage from your employer to avoid a Late Enrollment Penalty (LEP).

Do I have to pay for Part B?

Most people will pay a monthly premium of $170.10 for Part B.  This amount will be deducted from your Social Security check.  If you are not receiving Social Security, you will get a quarterly bill.  You also have the option of setting up a monthly EFT from your bank account.  Note, you will have to pay more for Part B if your income exceeds a certain level.

Does Part B pay for all my doctor’s bills?

Although Part B pays for a majority of your doctor bills, there is a substantial gap in coverage.  To start with, you have to pay a deductible ($233) each year for any Part B services you receive.   After that, Part B pays 80% and you will pay the remaining 20%.  Please note, there is no limit on the 20%.  You will pay 20% of Part B services until the total bill has been paid.  Because of this, most people will enroll in a Medicare Supplement to cover the 20%.  The easiest way to find the most suitable and competitively priced Medicare Supplement in Kansas is to call or text us at 913-717-6782 for a free consultation.

Can I delay enrolling in Medicare Part B if I have insurance from my employer?

Remember that you have a choice when deciding when to start Part B.  If you have “creditable” health coverage from your employer or your spouse’s employer you can delay enrolling in Part B without incurring a life-time penalty.  The size of your employer will determine whether or not you have creditable coverage.  If your employer has 20 or more employees then you may have creditable health care coverage.  It’s best to consult your employer’s benefit manager to make sure your coverage allows you to delay enrolling in Part B.

What will happen if I don’t enroll in Part B?

You will have to pay a late enrollment penalty (LEP) once you do sign up for Part B and will have to pay it the rest of your life.  The only way to avoid the LEP is to always have creditable health coverage once you turn 65.  Once you lose your health coverage after you turn 65, the LEP clock starts ticking.  Once this clock starts ticking, you will have eight months to enroll in Part B without incurring a LEP.

Don’t pay for Part B if you are still working and have creditable health coverage

We have clients that were automatically signed up for Part B when they turned 65 and they still had health insurance from an employer or spouse’s employer.  They mistakenly kept their Part B because they thought it was required.  In reality, they were paying for duplicate coverage.  If this happens, you can opt out of Part B by calling Social Security.  You can re-enroll in Part B when your employer coverage ends.  Just make sure you sign up for Part B within 8 months of losing your employer coverage to avoid a late enrollment penalty.  You can learn more about enrollment periods by going here.