Medicare Part B

Summary:

  • Medicare Part B is a part of "Original Medicare" which is made up of two parts: Medicare Part A and Medicare Part B.
  • Part A and Part B combine to cover medical and hospital insurance for individuals 65 years of age and older.
  • Can see any doctor in the country who accepts Medicare.
  • There is a seven-month period when you turn 65 called your Initial Enrollment Period (IEP) to enroll in Original Medicare–the month of your birthday plus 3 months before your birthday and 3 months after your birthday. If you miss this IEP, you’ll need to wait for the annual General Enrollment Period.

What is Medicare Part B?

Medicare Part B is the portion of Medicare that covers medical expenses and is often times referred to as "Medical Insurance". Some people automatically get Medicare Part B, and some people need to sign up for Part B.

If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.

What does Medicare Part B Cover?

  • Medically necessary services: services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice
  • Preventive services: health care to prevent illness (like the flue) or detect it at an early stage, when treatment is most likely to work best.
Medical Care

What are some examples of things covered?

What do I do if I'm unsure Medcare Part B will cover what I need?

  1. Talk to your doctor. They can advise on if the service or supplies you need will be covered by Medicare. If they do not think your particular situation will be covered, you will have to read and sign a notice that states you may have to pay for the service or supply out of pocket.
  2. Search Medicare.gov

Medicare Part B coverage is based on 3 main factors:

  1. Federal and State Laws
  2. National coverage decisions made by Medicare
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

How much does Medicare Part B cost?

For Medicare Part B you will need to pay a premium each month. This premium is automatically deducted from your benefit payment if you get benefits from any of the following:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you are not currently getting any of the above benefits, you will receive a bill. Most people will be billed the standard premium amount.

The standard Medicare Part B premium for 2022 is $170.10. You may pay more if your adjusted gross income (AGI) from your filed IRS tax return from 2 years ago is above a certain threshold. If that is the case, you'll pay the standard amount as well as an Income Related Monthly Adjusted Amount (IRMAA).

If your annual income in 2020 (for what you pay in 2022) was: Per Month Payment
(in 2022)
File Individual Tax Return File Joint Tax Return File Married + Separate Tax Return
$91,000 or less $182,000 or less $91,000 or less $170.10
$91,001 - $114,000 $182,001 - $228,000 Not applicable $238. 10
$114,001 - $142,000 $228,001 - $284,000 Not applicable $340.20
$142,001 - $170,000 $284,001 - $340,000 Not applicable $442.30
$170,001 - $499,999 $340,001 - $749,999 $91,001 - $408,999 $544.30
$500,000 or more $750,000 or more $409,000 or more $578.30

Medicare Part B Deductible & Co-Insurance

For 2022, you will pay $233 for your Part B deductible. After that deductible is paid for the year, you typically pay 20% of the Medicare-Approved Amount for the following services:

  • Most doctor services (including while inpatient at the hospital)
  • Outpatient therapy
  • Durable Medical Equipment (DME)

Who is eligible for Medicare Part B?

The eligibility rules for Part B depend on whether you are eligible for premium-free Part A or whether you have to pay a premium for Medicare Part A.

If you are eligible for premium-free Part A, you are also eligible for enroll in Part B once you have enrolled in Part A.  Enrollment in Part B can only happen at certain times.

If you are responsible for paying a premium for Medicare Part A, you must meet the following requirements to enroll in Part B:

  • Be age 65 or older;
  • Be a U.S. resident; AND
  • Be either a U.S. citizen, OR
  • Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

NOTE: Part B is a voluntary program which requires the payment of a monthly premium for all months of coverage.

Is Medicare Right for You?

When can I enroll in Medicare Part B?

The majority of Americans who choose Medicare health insurance plans are 65 years of age or older. You have the option to sign up for just Medicare Part A, or both Medicare Part A and Medicare Part B. Once you are ready, there are 3 times you can sign up for Medicare:

  1. Initial Enrollment Period - this is a 7-month period that begins 3 months prior to the month you turn 65, the month you turn 65, and the 3 months after you turn 65.
    • For example, if you turn 65 in July:
      Three months before your birth month: April, May, June
      Your birth month: July
      Three months after your birth month: August, September, October
    • Medicare Part A is free for most people. Depending on your employment and tax history, you may need to pay for Part A.
    • In most cases, if you do not sign up for Part B when you are first eligible, you will need to pay a late enrollment penalty and could have a gap in your health coverage
  2. Special Enrollment Period - once the initial enrollment period ends, you may have a chance to sing up for Part A (if you need to purchase it) and Part B during this special enrollment time, but only if you meet certain requirements.
    • If you're covered under a group health plan based on current employment
    • you have a Special Enrollment Period to sign up for Part A and/or B at any time as long as you are working
    • You're covered by a group health plan through the employer or union that you work for
    • Note: this special enrollment period does not apply if you have End-Stage Renal Disease (ESRD) or Veterans Affairs and Individual Health Insurance Marketplace coverage.
  3. General Enrollment Period - if you miss the initial enrollment period and do not qualify for the special enrollment period, you may have to wait until the Medicare General Enrollment Period (January - March 31), with coverage starting July 1 of that year. In most cases you will have to pay a late enrollment penalty if you enroll during this period.

For some people with specific disabilities and illnesses, Medicare is available before they reach 65 years of age. These individuals must:

  • have received Social Security Disability benefits for 24 months or
  • have End Stage Renal Disease (ESRD) or
  • Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease)

I'm ready to sign up for Part A and/or Part B, what now?

While Medicare provides your coverage, you'll sign up through Social Security (or the Railroad Retirement Board) as they need to see you're eligible for Medicare.

I want to sign up for Medicare Part A & Part B at the same time:

  • Apply online (at Social Security) – This is the easiest and fastest way to sign up and get any financial help you may need. You’ll need to create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online.
  • Call 1-800-772-1213. TTY users can call 1-800-325-0778.
  • Contact your local Social Security office.
  • If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

If you don’t qualify for Part A without having to pay a monthly premium, you might be able to buy Part A. To buy Part A, you must also sign up for Part B.

I already have Medicare Part A & want to add Part B:

Contact Social Security to sign up for Part B:

Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance.  A licensed agent/producer may contact you.  Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.  MasterCare America, Inc. and Insuractive LLC are licensed and certified representatives of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans they represent do not discriminate on the basis of race, color, national origin, age, disability, or sex.  For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov

Recommended Reading

Original Medicare

Original Medicare is made up of two parts: Medicare Part A and Medicare Part B.

Medicare Part A

Medicare Part A is a portion of Original Medicare that is often times referred to as "Hospital Insurance".

Medicare Supplement

Medicare Supplement insurance (also known as Medigap) is helps supplement some of the healthcare costs not covered by Original Medicare (Part A and B).