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Medicare Part B

People often describe Medicare Part B as medical coverage outside of the hospital. However, this is not quite accurate. Medicare Part B covers things in and out of the hospital and should be viewed more as coverage that is facilitated and ordered by a doctor.

Medicare Part B covers many outpatient medical services. It covers preventive and ordinary services like mammograms, colonoscopies, flu shots and much more. Things like doctor visits and lab tests are also covered. Some chiropractic care and ambulance rides can be covered too.

Part B covers things that happen in the hospital too. Medicare Part B covers things like chemo and radiation for cancer treatments, medical equipment and imaging services.

Do I have to Get Medicare Part B

Medicare Part B

Remember, even though Part B is optional you definitely need it if you have Medicare as your primary coverage. You can not purchase a Medigap plan without Medicare Part B. Medicare Part B has a monthly premium that you need to pay each month. The government sets that premium amount and most people will pay the set rate. For 2019, the premium amount is $135.50 for newly enrolled Medicare members. While this sounds like a lot of premium, the Federal Government is picking up the other 75%.

If your income is above a certain amount, you may be required to pay more. Typically less than 5% of Medicare members pay more than the set monthly premium.

There may also be a penalty fee attached to your Part B premium if you enroll late to Part B. This penalty fee is for life, so it is important to know when your your enrollment window is, and not miss it! This window can be when you retire and lose access to your group benefits through an employer. If you do not know when your enrollment window is, please contact us to help you sort through those questions.

Signing Up for Medicare Part B

Medicare Part B and Prescriptions

People who are already receiving Social Security benefits before age 65 don’t have to enroll because the Social Security office automatically enrolls you. You will receive your card in the mail a month or two before your 65th birthday. Everyone else needs to enroll in Medicare Part B when you turn 65. It takes several weeks to process your application and receive the card, so make sure you apply a bit before you need the coverage. You can sign up online, in person at the local Social Security office or on the phone.

Medicare Part B will not cover any medical expenses that are covered by Medicare Part A. Dental care, vision, hearing, cosmetic or some foot care. Medicare Part B does not cover prescription medications that you would pick up in a pharmacy. Retail pharmacy medications require a Medicare Part D drug plan.  

Costs of Medicare Part B

You will pay a percentage of the costs of your Medicare Part B services. These costs generally include things like your annual Medicare Part B deductible $203.00, 20% of the remaining costs (no caps or limits on the 20%), and any excess charges that you may incur above what Medicare pays. Obviously, that 20% cost-sharing can be significant for your care depending on your services needed. The 20% cost-share on cancer treatments and surgeries can add up quickly, however, there is no reason to fear this because of the availability of many supplement coverage options. We can help you find a good fit for your budget.  Another cost associated with Part B is the Part B excess charge.  This is a charge that a doctor can charge you if they are contracted by Medicare, but do not accept Medicare Assignment.

Part B Deductible Warning

If the Medigap Plan you choose does not pay the Part B Deductible, do not pay it at the doctor’s office.  Instead, tell them to process it through Medicare and then bill you for it.  This is the standard operating procedure and could end up saving you a lot of headaches later on in the year, with another doctor.

You can protect yourself from major medical expenses by having either a Medicare Supplement or a Medicare Advantage plan. There are differences between states and plans, so reach out to us for a personalized plan to fit your personal needs by calling 352-508-4221 or by contacting us.