What Is Medicare Part B Medical Insurance
Medicare Part B provides outpatient/medical coverage. The list below provides a summary of Part B-covered services and coverage rules:
This list includes commonly covered services and items, but it is not a complete list. Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing for Medicare-covered services.
The 2022 Part-B premium is $170.10 per month
Medicare Part B Financial Assistance
Because Medicare Part B requires a monthly payment for its services, some people may find it difficult to pay for the monthly costs associated with this portion of Medicare. Those with limited incomes, in particular, may wonder if there are cost assistance programs in place to help mitigate the financial burden.
In fact, there are a few ways that you can reduce your monthly premiums, or at least make your healthcare more affordable using different programs. One such way is to enroll in a Medicare Savings Program. Run by individual states in conjunction with Medicare, Medicare Savings Plans help you pay for medical costs associated with deductibles, coinsurance and copayments, in some cases. There are four Medicare Savings Programs available, but only three of them relate to Medicare Part B. They are:
The Qualified Medicare Beneficiary Program
- The Qualifying Individual Program
- The Specified Low-Income Medicare Beneficiary Program
Each program has its own eligibility requirements. For example, members of the QI Program must apply every year for assistance. Acceptance is based on a first-come, first-served basis, with priority given to past recipients. You also wont qualify for the QI Program if you receive Medicaid benefits. If you think that you qualify for one of these programs or need financial assistance, then you should contact the Medicaid program in your state to find out more information.
What Is Excluded From Medicare Part B
Medicare will not pay for medical care that it does not consider medically necessary. This includes some elective and most cosmetic surgery, plus virtually all alternative forms of medical care such as acupuncture, acupressure, and homeopathywith the one exception of the limited use of chiropractors.
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Medicare Part B And Coinsurance/copayments
You usually pay a 20% coinsurance amount for covered services. If your doctor or health care provider accepts Medicare assignment for a covered service, you would pay the Part B deductible along with 20% of the Medicare-approved amount for services rendered. Accepting assignment means that your doctor will not charge you more than the Medicare-approved amount for the covered service. You would still be responsible for cost-sharing.
Common Services That Medicare Does And Doesnt Cover
Heres general info about what Medicare does or doesnt cover for common health care needs. Visit medicare.gov/coverage for more detail. Also, check a Medicare health plans Summary of Benefits to learn whats covered.
Medicare has some coverage for acupuncture and it is limited to treatment of chronic low back pain. Some Medicare Advantage plans have benefits that help pay for acupuncture services beyond Medicare such as treatment of chronic pain in other parts of the body, headaches and nausea.
Assisted living is housing where people get help with daily activities like personal care or housekeeping. Medicare doesnt cover costs to live in an assisted living facility or a nursing home.
Medicare Part A may cover care in a skilled nursing facility if it is medically necessary. This is usually short term for recovery from an illness or injury.
The federal Medicaid program can help pay costs for nursing homes or services to help with daily living activities.
Medicare Part B covers outpatient surgery to correct cataracts. It also pays for corrective lenses if an intraocular lens was implanted. Coverage is one pair of standard frame eyeglasses or contact lenses as needed after the surgery.
Medicare Part B covers a chiropractors manual alignment of the spine when one or more bones are out of position. Medicare doesnt cover other chiropractic tests or services like X-rays, massage therapy or acupuncture.
What Will Medicare Part B Cost
Medicare Part B requires a monthly premium,4 which will be automatically deducted from any benefit youre receiving from Social Security, the Railroad Retirement Board or the Office of Personnel Management. Otherwise, youll get a bill.
Youll generally pay a standard premium amount unless your modified adjusted gross income is over a certain amount. For this calculation, Medicare uses your IRS tax return from two years prior to identify whether youre a higher-income beneficiary. If you are, youll pay an income-related monthly adjustment amount . Heres how it works.
If your yearly income in 2020 was:
|File taxes as an individual||File taxes as married filing jointly||File taxes as married, filing separately||Youll pay each month in 2022*|
|$91,000 or less|
In addition to your monthly premiums, Medicare Part B has a deductible of $233 in 2022. Once you hit your deductible during the year, youll usually be responsible for 20% of Medicare charges for all Part B services .
Although the costs above are standard, if you dont enroll in Part B when youre first eligible and you didnt have a valid reason to delay enrollment your premium may go up 10% for each 12-month period you couldve had it .5 In most cases, youll pay this late enrollment penalty for as long as you have Part B, so dont miss your window.
What Does Original Medicare Part B Cover
While Original Medicare Part A, with its coverage for hospital visits and skilled nursing care, can help you manage the big stuff, thats only part of the picture. Original Medicare Part B helps you get the care you need for a lot of the other stuff that requires a doctors care. And you can receive care from any doctor who accepts Medicare patients.
Original Medicare Part B helps cover:
- Medically necessary doctors services
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How Do You Sign Up For Medicare Part B
Signing up for Medicare Part B depends on your situation. In some cases, enrollment is automatic, and in others you must apply. If youre already receiving benefits from Social Security or the Railroad Retirement Board for at least four months before you turn 65, youll be automatically enrolled. If thats not the case, you can apply online at ssa.gov/medicare.6
That said, while most people should enroll in Medicare Part A, some people may choose to delay signing up for Part B. This typically depends on the kind of health coverage you have. For instance, if youre working and you still have health coverage through a job, or you have coverage through your spouse whos still working, you may be able to delay coverage without paying a late enrollment penalty.7 There are a lot of nuances find out about those and other situations here.
If you have Lou Gehrigs disease , end-stage renal disease , or youre under 65 and you are receiving Social Security Disability Insurance benefits, find out about enrollment here.
How To Replace Your Medicare Card
Call 1-800-MEDICARE and follow the automated prompts for reporting and replacing a lost or stolen card. You may also print a temporary copy of your card through your MyMedicare.gov account.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christians passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelors degree in journalism.
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S Of Medicare Basics Part B
The best place to start learning about Medicare is with the basics with Parts A, B, C and D. The second in a four-part series, this Medicare Basics article will focus on Medicare Part B.
Medicare Part B is one part of what is known as Original Medicare, which is administered by the federal government and also includes Medicare Part A. Part B covers your doctor visits, most doctor services you receive as a hospital inpatient, most routine and emergency medical services, and some preventative care items.
What Is The Medicare Part B Premium For 2021
Medicare Part B Premium and Deductible The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.
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Medicare Part B Penalty Cost For Late Enrollment
If you choose not to enroll in Medicare Part B when you first become eligible, you may have to pay ongoing penalty fees if you decide to enroll later. For each 12-month period that you could have had Part B, your monthly premium may increase by 10%. For example, if you have been eligible for Part B for the last 3 years but did not sign up until now, your monthly premiums could go up by 30% 10% for each 12-month period you didnt have coverage.
Its also worth noting that this penalty applies for as long as you have Part B, meaning the 30% premium increase is permanent.
Medicare Part B Premium For 2022
The standard monthly Part B premium has increased from the past years amount.
For Medicare recipients, Part B coverage is known as your medical insurance. It helps to cover costs for doctor services, outpatient therapy, durable medical equipment, and other medically necessary services and preventive services not covered by Part A.
To receive your Medicare Part B coverage, you must pay a monthly premium amount, which is adjusted in accordance with the Social Security Act and correlates with your annual income.
The 2022 Medicare Part B monthly premium amount has increased for each income bracket from the 2021 amounts, which we will outline in greater detail below.
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Can You Be On Medicare And Still Work
Key takeaways: You can get Medicare coverage if you’re still working. If you or your spouse work for a large employer that provides insurance, you can often put off enrollment without penalty. If you work for a company that has fewer than 20 employees, you must sign up for Medicare as soon as you are eligible.
When Can I Apply For Medicare Part B
There are four enrollment periods during which you may choose Medicare coverage.
Initial Enrollment Period: You can sign up for Medicare during a seven-month Initial Enrollment Period . This period includes the three months before your 65th birthday, the month of your birthday, and the three months after you turn 65.
General Enrollment Period: If you miss your Initial Enrollment Period for Medicare coverage, you may sign up for Medicare between January 1 and March 31 each year during a General Enrollment Period. You could face a late penalty for missing your initial opportunity to enroll in Medicare, but you will be able to apply for coverage during this time.
Annual Election Period: Each year from October 15 to December 7, you may sign up for Medicare coverage or prescription drug coverage to begin January 1 of the following year. Additionally, changes may be made to any existing Medicare plan during this time.
Special Election Period: If you experience a loss of health insurance coverage that was previously covered by your job or union health insurance, you may qualify for a Medicare special enrollment period. This eligibility period will be determined based on the date you lost coverage.
If you fall within one of the four enrollment periods for Medicare coverage, compare Medicare plans with Blue Cross and Blue Shield of Alabama today.
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What Is Part B For Medicare
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Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. Cost: If you have Part B, you pay a Part B premium each month.
How Is A Medicare Beneficiary Identifier Formatted
A Medicare MBI number contains 11 characters, which are randomly generated without underlying meaning. The MBI number is a string of numbers and upper-case letters, which will include an arbitrary combination of digits and any letters in the alphabet except B, I, L, O, S, and Z. These are excluded to prevent confusion with similar-looking letters. There are no hyphens or spaces in these sequences, so if you see an example of an MBI that has them, remember that this is only for illustration purposes. If you include these characters in your claim, it could be rejected.
On a Medicare card, an MBI will appear similar to this: 1EG4-TE5-MK73. The second, fifth, eighth, and ninth characters are always letters while the first, fourth, seventh, tenth, and eleventh characters are always numbers. You can visit cms.gov for more information on the format of an MBI.
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What Does Medicare Part A Cover
Medicare Part A covers the hospital charges and most of the services you receive when you’re in the hospital.
What is covered by Medicare Part A
Hospital stays and inpatient care, including:
Medications for pain and symptom management:
Up to $5 per prescription
Durable medical equipment used at home and respite care:
Home hospice patients may pay a small coinsurance amount for inpatient respite care or durable medical equipment used at home.
*Lifetime reserve days are a set number of covered hospital days you can draw on if youre in the hospital longer than 90 days. You have 60. Each lifetime reserve day may be used only once, but you may apply the days to different benefit periods. Lifetime reserve days may not be used to extend coverage in a skilled nursing facility.
When Can I Enroll In Medicare Part B
If you are receiving retirement benefits before age 65 or qualify for Medicare through disability, generally youâre automatically enrolled in Medicare Part A and Part B as soon as you become eligible.
If you do not enroll during your initial enrollment period and do not qualify for a special enrollment period, you can also sign up during the annual General Enrollment Period, which runs from January 1 to March 31, with coverage starting July 1. You may have to pay a late enrollment penalty for not signing up when you were first eligible.
If youâre not automatically enrolled, you can apply for Medicare through Social Security, either in person at a local Social Security office, through the Social Security website, or by calling 1-800-772-1213 from 8AM to 7PM, Monday through Friday, all U.S. time zones.
Keep in mind that once you are both 65 years or older and have Medicare Part B, your six-month Medigap Open Enrollment Period begins. This is the best time to purchase a Medicare Supplement insurance plan because during open enrollment, you have a âguaranteed-issue rightâ to buy any Medigap plan without medical underwriting or paying a higher premium due to a pre-existing condition**. Once you are enrolled in Medicare Part B, be careful not to miss this one-time initial guaranteed-issue enrollment period for Medigap.
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Other Ways To Obtain A Medicaid Provider Number
The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2. Atlanta, Chicago and New York are just a few to mention. If you want to enroll in the Medicare provider services program in person, go to the nearest regional office.
Any questions related to the enrollment process and other services can be communicated by phone 2. For example, if you have general questions about the program, you may call 800-633-4227, the Medicaid phone number. Another option is to access CMS.gov, select Contacts Database and search for a Medicaid office for a Medicaid customer service representative in your area.
Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state. Signatures must be handwritten. The application forms are available on the CMS.gov website under the Enrollment Applications section.
- The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2.
- Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state.
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What Medicare Part B Covers
First, lets take a look at what Medicare Part B actually covers. Medicare Part B covers medical treatments and services under two classifications: medically necessary services and preventive services. What qualifies something as medically necessary? In general, medically necessary services must be medical treatments that are required to treat a recognized medical condition or illness. Necessary services and items might include the following:
- Diagnostic equipment
- Supplies, such as walkers or wheelchairs
For example, diabetics need regular doctor visits to ensure appropriate blood levels, as well as appropriate diagnostic coverage to ensure accurate readings.
Medicare Part B beneficiaries also gain access to preventive services, like yearly screenings for the flu or certain cancers. In addition, Part B may cover other medical procedures and treatments that fall within the necessary or preventive range. Ambulance services, clinical research, mental health counseling and some prescription drugs for outpatient treatment may all be covered under Medicare Part B.
As of the 2019 plan year, the Centers for Medicare and Medicaid Services has lifted coverage caps on critical services covered under Medicare Part B. These include physical therapy, speech language pathology and occupational therapy.
But original Medicare doesnt cover everything. You may need to obtain supplemental insurance, such as Medigap, if you need coverage for the following:
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