Understanding the difference the different parts of Medicare is essential to protecting your health and your bank account. Medicare Part B is the second part of Medicare and the part you’ll likely use the most.
What is Medicare Part B?
Medicare Part B is your doctors’ insurance and is part of your Original Medicare benefits. This second part of Medicare provides coverage for all your outpatient medical care services.
How The Different Parts of Medicare Work Together
Medicare is composed of four separate parts. All of which are voluntary. Each part provides a different piece to form comprehensive protection.
- Part A – Hospital insurance, which covers inpatient medical care.
- Part B – Doctors insurance, which covers outpatient medical care.
- Part C (Medicare Advantage) – Private health insurance plans that expand your benefits to include vision, dental, hearing, and prescription drugs.
- Part D – Prescription drug coverage
What Does Medicare Part B Cover?
Everything covered under Medicare Part B falls into two categories:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventative services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Part B covers things like:
- Office visits
- Physician services
- Lab testing
- Ambulance Rides
- Simple Surgical Procedures
- And other care services that fall under Medically necessary or preventative
If you’re new to Medicare, you may be wondering about a specific test, service, or care item. You can search your Medicare coverage here. And it’s always a good idea to ask your doctor if what they are recommending is covered by Medicare.
What Medicare Part B Doesn’t Cover
Medicare Part B does not cover any inpatient medical care services. All inpatient medical care is covered through your Medicare Part A benefits. Additionally, Part B does not provide prescription drug coverage, which you’ll have to get by enrolling in Medicare Part D.
Part B does not cover any outpatient medical care not deemed medically necessary or preventative. Unfortunately, dental, vision, and hearing care services are not covered under Medicare Part B. To get these benefits, you must enroll in Medicare Advantage.
Get Free Medicare Help
Medicare Part B Costs
Unlike Medicare Part A in which most Medicare beneficiaries receive their benefits for free, Medicare Part B does have a monthly premium, a yearly deductible, and 20% coinsurance on all covered services.
Part B Premium: The standard Part B premium in 2021is $148.50. The majority of Medicare beneficiaries will pay the standard amount. However, higher-income individuals pay an extra charge added to their monthly premium.
If you receive benefits from Social Security, Railroad Retirement Board, or the Office of Personal Management, then your Part B premiums are automatically deducted.
Deductible: In 2021, your annual deductible is $203 for your Part B benefits. Unlike Part A, this is an annual deductible, and you only have to have this deductible once.
Coinsurance: After meeting the annual deductible, your Part B benefits cover 80% of the Medicare-approved amount for all the services listed above. In other words, you pay 20% coinsurance for all your outpatient medical care services. There is no out of pocket limit for this coinsurance and is the biggest financial gap looming within Medicare.
Fill Medicare’s Financial Gaps
Although Medicare provides excellent insurance coverage, it’s far from comprehensive. Just within Medicare Part B, there are monthly premiums, an annual deductible, and an uncapped 20% copay on all covered services. These out of pocket costs can reach many thousands of dollars for individuals in poor health. The good news is that there are two options for filling these financial gaps within both Medicare Part A and Part B.
Medicare Supplemental Insurance (Medigap) – there are 10 different Medigap plans. Each plan covers a different set of financial gaps within Original Medicare. These plans do not add any additional services or benefits but do cover deductibles, coinsurance, and copays to help you keep money in your pocket.
Medicare Advantage – These private insurance plans fill the financial gaps of Medicare and also expand your benefits to include vision, dental, hearing, and prescription drugs. Medicare Advantage bundles all these benefits into one single monthly premium and is an all in one solution to your health care needs.
When To Enroll
Your initial Medicare Enrollment Period is a seven-month window that begins three months before your 65th birthday, includes your birthday month, and extends for the following three months.
It’s critical that you do not miss your initial enrollment window and sign up for Medicare Part B. If you fail to enroll in Part B when first eligible, there is a 10% late penalty for each 12 month period that you could’ve had Part B. The penalty is permanent and remains the entire time you’re on Medicare. The three other parts of Medicare do not have financial penalties for signing up after the initial enrollment period.