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This part of the Medicare program helps pay for preventive care, doctor visits, and medically necessary services.
Medicare Part B includes preventive care, medical services, and outpatient care
You must pay a premium for Medicare Part B coverage, but you may be able to delay enrolling in it
For 2019, the monthly premium rate starts at $135.50, but the premium could be higher if your income is higher
Medicare Part A and B make up Original Medicare
Medicare Part B is known as medical insurance. One of four parts of Medicare, Part B broadly covers a wide range of care, including doctor’s visits, preventive services, surgeries, medical equipment, and outpatient hospital visits. Medicare Part B, when combined with Medicare Part A (which covers inpatient care) is known as Original Medicare.
If you receive federal retirement benefits, you get automatically enrolled in Medicare Part A and Medicare Part B on the first day of the month you turn 65. However, you can opt out of receiving Part B, if for instance you are still working and get employer-sponsored health insurance.
Unlike Part A, which is typically free, Medicare beneficiaries have to pay a premium for Part B. As of 2019, the monthly cost starts at $135.50 and increases based on your income. While preventive services are free, other Medicare Part B benefits are subject to some costs, like a low $185 deductible, coinsurance, and copays.
Before we start, you can brush up on Medicare here. This federal health insurance program is designed to cover Americans 65 and older and some younger Americans with permanent disabilities.
In this article:
The standard Medicare Part B premium in 2019 is $135.50 a month, but you could pay more. Your monthly premium is determined by the modified adjusted gross income (MAGI) reported on your IRS tax return from two years ago.
Here are the 2019 premiums, based on income levels for the 2017 tax year:
|Individual tax filers||Married filing jointly||Premium|
|$85,000 or less||$170,000 or less||$135.50|
|$85,001 to $107,000||$170,001 to $214,000||$189.60|
|$107,001 to $133,500||$214,001 to $267,000||$270.90|
|$133,501 to $160,000||$267,001 to $320,000||$352.20|
|$160,001 to $500,000||$320,001 to less than $750,000||$433.40|
|$500,000 or more||$750,000 or more||$460.50|
|Married or living together, filing separate||Premium|
|$85,000 or less||$135.50|
|$85,001 to $414,999||$433.40|
|$415,000 or more||$460.50|
Learn more about the total costs of Medicare.
Medicare Part B recipients also have an annual deductible of $185. This is how much you must spend in out-of-pocket expenses before Medicare starts to help cover the costs.
Read about how a health insurance deductible works.
Medicare helps to make medical costs affordable by paying doctors and hospitals a Medicare-approved amount for services. If you get a medical service that’s costs more than the Medicare-approved amount, you’ll pay the difference. Namely, a 20% coinsurance on the Medicare-approved amount. You only pay for 20% of the costs and Medicare pays for the remaining 80%. Learn more about coinsurance.
Depending on where the service is performed, you might have to pay a small copay, or fixed amount. For example, if you have chemotherapy as part of outpatient care, you may have to pay a copay. Learn more about copays.
Unlike with traditional health insurance, the government does not set an out-of-pocket maximum. That means there is no cap on how much you can spend on your own for health care.
If you typically seek a lot of medical care during the year and need help paying for the costs, you might consider getting supplemental insurance through a Medigap policy. Also called Medicare Supplement Insurance, it helps cover the out-of-pocket expenses we mentioned above. Learn more about Medigap.
Part B of Medicare covers many services that you might need, including preventive services. Some of these Medicare benefits might have restrictions or conditions for Medicare to help cover it. (For example, if you need an organ transplant, it must be done in a Medicare-approved hospital. Another example is that you must be age 55 to 77 to qualify for a lung cancer screening.)
Medicare Part B coverage includes the following:
|20% Coinsurance||Free preventive care|
|Ambulance services||Abdominal aortic aneurysm screening|
|Blood||Alcohol misuse screening and counseling|
|Cardiac rehabilitation||Bone density screening|
|Chemotherapy||Cardiovascular disease screening and behavior therapy|
|Chiropractic services||Colorectal cancer screening|
|Continuous positive airway pressure (CPAP) therapy||Depression screening|
|Durable medical equipment (DME)||Glaucoma test|
|Emergency department services||HPV test|
|Eyeglasses after cataract surgery||HIV and STI screenings|
|Home health services||Hepatitis B shots and infection screening|
|Kidney dialysis||Hepatitis C screening|
|Laboratory services (certain blood tests, urinalysis)||Lung cancer screening|
|Mental health coverage||Mammogram|
|Organ transplant (heart, lung, kidney, pancreas, intestine, liver)||Medical nutrition therapy|
|Physical and occupational therapy||Obesity screening and counseling|
|Prescription drugs* (limited)||Pelvic exams|
|Prosthetic and orthotic items||Prostate cancer screening|
|Pulmonary rehabilitation||Smoking and tobacco cessation counseling|
|Second surgical opinion||Vaccines (flu shots and pneumococcal shots)|
|Speech-language pathology services||Wellness visit|
|X-Rays, MRIs, CT scans, and EKG/ECG screenings|
|Transitional care management services|
*Prescription drugs are only covered in certain circumstances, such as part of outpatient treatment.
Medicare Part B covers the care you get at an emergency room or hospital as an outpatient. Covered services include observational care and the medical services listed above. If you’re an outpatient, it means that your doctor hasn’t ordered you to be formally admitted to the hospital.
If you have, then you’re an inpatient and care you receive will be covered by Medicare Part A.
As with other parts of Medicare, and health insurance in general, Part B has exceptions. 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.
Since Original Medicare (Parts A and B) do not cover everything, some Medicare recipients opt for Medicare Part C. Also known as Medicare Advantage, these health insurance policies are provided by Medicare-approved private health insurance companies and may cover additional services — like dental or vision care — or help lower out-of-pocket expenses.
However, to get a Medicare Advantage plan, you still need to enroll in Original Medicare and pay your Medicare Part B premium in addition to the Medicare Advantage premium. The exact cost and benefits will depend on the insurer and the plan that you choose. Part C plans often operate like private health insurance plans and may come with their own restrictions on how to use them.
Read more about Medicare Part C.
If you’re already receiving Social Security benefits, you get automatically enrolled in Medicare Part A and Medicare Part B on the first day of the month you turn 65.
Otherwise, you will need to sign up yourself during your initial enrollment period, which starts three months before you turn 65. You can also sign up for Medicare during Medicare Open Enrollment, which lasts from October 15th until December 7th. (Note: the enrollment period for Medicare differs from the one for individual plans you buy on the Obamacare marketplace.)
You can apply by visiting your local Social Security office, calling Medicare at 1-800-772-1213, or simply filling out an application online at the Social Security Administration website. Here is a step-by-step guide to applying for Medicare.
Some people choose to delay enrolling in Part B. This is often the case if they are are still working and receive health insurance coverage through their workplace, or if they’re on their spouse’s health insurance plan.
If your workplace has 20 more employees, you may choose to keep employer-sponsored coverage and save from paying the Part B monthly premium. Once you leave work and retire, you will be given an eight-month special enrollment period to apply for Medicare Part B.
If you don’t sign up during special enrollment, you’ll have to wait until general Medicare open enrollment starts on January 1 to sign up for coverage that won’t be effective until July 1. You’ll also have to pay a lifetime late-enrollment penalty — a monthly penalty that lasts as long as you have Part B.
Learn more about how to apply 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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