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Medicare Part B is outpatient or doctor insurance. It covers medical services and supplies used to treat health conditions and provide preventative care.
Medicare is the federal health insurance program that covers Americans 65 and older. It also covers younger Americans with certain disabilities or illnesses. The program is administered by the Centers for Medicare and Medicaid Services. Medicare comes in four Parts: A, B, C and D. Here’s what you need to know about Medicare Part B.
Medicare Part B is outpatient or doctor insurance. It covers medical services and supplies used to treat health conditions and provide preventative care. Medicare Part B works in tandem with Medicare Part A, which covers inpatient or hospital services. Together, they’re known as Original Medicare.
Medicare Part C is a private alternative to Original Medicare. Medicare Part D is coverage for prescription drugs.
You can shop for private Medicare Part C or Medicare Part D plans after you enroll in Original Medicare. (Our partner Via Benefits can help you find and compare Medicare plans in your area.)
The standard Medicare Part B premium in 2018 is $134, but you may pay less ($130 on average) if you’re getting Social Security. You could also pay more, depending on your income. Here’s how your income as of 2016 sets your 2018 premiums.
|Individual tax filers||Married filing jointly||Married filing separately||Premium|
|$85,000 or less||$170,000 or less||$85,000 or less||$134|
|$85,001 to $107,000||$170,001 to $214,000||N/A||$187.50|
|$107,001 to $133,500||$214,001 to $267,000||N/A||$267.90|
|$133,501 to $160,000||$267,001 to $320,000||N/A||$348.30|
|over $160,000||over $320,000||over $85,000||$428.60|
Medicare Part B recipients also have an annual deductible of $183 and 20% coinsurance for covered supplies and services.
Learn more about the total costs of Medicare.
Broadly, Medicare Part B covers doctor visits, health screenings, certain vaccinations and other medically necessary services or supplies related to outpatient treatment or preventative care. It also covers the following:
Most vaccinations are covered by Medicare Part D or a Medicare Part C plan offering prescription drug coverage. However, Medicare Part B will cover certain immunizations. These vaccines include:
Medicare Part B also helps pay for certain vaccines when they're directly related to the treatment of an injury or illness. For instance, if you were to step on a rusty nail, Medicare Part B might cover the tetanus shot.
Examples of vaccinations Medicare Part B won't generally won't cover include:
Instead, Medicare Part D or a Medicare Part C plan with drug coverage would cover these vaccinations. However, consult with your drug formulary or insurer, respectively, to make sure a particular shot is covered and what copay or coinsurance you'll be expected to pay before getting the immunization.
As with other parts of Medicare — and health insurance in general — Part B has exceptions. Notably, it does not cover the following:
You can find out if a service, item or procedure is covered by Medicare Part B on the Medicare website. You can also ask your doctor or health care provider if Medicare will cover something they’re prescribing.
Think of Medicare Part B as doctor insurance. It covers outpatient treatment and preventative care. Medicare Part A, conversely, is hospital insurance. It covers inpatient treatment for your health conditions. You can get a better idea of what each one covers in the chart below.
Medicare Part B vs. Medicare Part A
|Medicare Part B||Medicare Part A|
|Nursing home stays||X|
Medicare Part A and Medicare Part B are designed to work together: You’re automatically enrolled in both coverages, once you’re 65 and receiving (or eligible to receive) federal retirement benefits.
At that point in time, Medicare Part A is premium-free. It’s also premium-free for anyone under 65 and on federal disability for 24 months or diagnosed with end-stage kidney disease. All Medicare Part B enrollees must pay a monthly premium based on income.
Due to aforementioned exclusions, some Medicare recipients opt for Medicare Part C, more commonly referred to as a Medicare Advantage plan. These Medicare-approved private health insurance policies may cover additional services (see dental or vision care) or lower out-of-pocket expenses. You still need to enroll in Original Medicare — and pay your Medicare Part B premium — to get a Medicare Advantage plan.
You qualify for Medicare Part B once you turn 65 years old so long as you’re a U.S. citizen or permanent resident. You also qualify for Medicare Part B if you are under 65, but on federal disability benefits for a period of time, usually 24 months.
If you’re on federal retirement benefits, your’e automatically enrolled in Original Medicare — Medicare Part A and Medicare Part B — on the first day of the month you turn 65. If you are on federal disability benefits, you get automatically enrolled for Original Medicare at 24 months.
Otherwise, you have to enroll on your own. You can do so by visiting your local Social Security office or calling Medicare at 1-800-772-1213. You can also fill out a Medicare application online at the Social Security Administration website.
Here is a step-by-step to applying for Medicare.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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