What Does Medicare Part B Cover
Medicare Part B covers 80 percent of the Medicare-approved costs of certain services. Most, though not all, of these services are administered on an outpatient basis. This means you dont receive them as a patient in a hospital.
There are some exceptions to this, such as emergency room visits and the services you receive there, even if youre later admitted to a hospital.
In order to get coverage, your care must be administered by a Medicare-approved supplier, such as an MD, DO, NP, or other medical professionals.
Services that Medicare Part B covers include:
- most doctors visits that are medically necessary or preventive, provided that theyre from a Medicare-approved supplier
- medically necessary outpatient hospital care, such as emergency room services and some same-day surgical procedures
What Parts A And B Don’t Cover
The largest and most important item that traditional Medicare doesn’t cover is long-term care if the only care you need is custodial. If you are diagnosed with a chronic condition that requires ongoing long-term personal care assistance, the kind that requires an assisted-living facility, Medicare will cover none of the cost. However, Medicare will cover the costs for acute-care hospital services, for patients who are transferred from an intensive care or critical care unit. Services covered could include head trauma treatment or respiratory therapy.
Why Should I Consider Enrolling In Medicare
When you turn 65 and are retired, many health insurance carriers assume that youll be on Medicare Part B. In turn, many people experience slight changes in their health insurance coverage as time goes on, even with FEHB. Does it impact everyone? Sometimes not someones health needs may be more simplistic and their FEHB in retirement sufficiently covers their needs. For others, it might be different.
Remember, health insurance carriers are for-profit organizations, even those through FEHB. As such, they will make business decisions about certain health coverages in a manner that works best for them. Carriers frequently change their health care coverage, and some day that coverage change could impact you in a way that can be devastating. This is why we always encourage the families we serve to review their health coverages again in open season, even if theyre not making changes.
I have a client who personally experienced receiving health services that were no longer covered by FEHB as they progressed through retirement, because the insurance carrier passed on that coverage responsibility to Medicare as the primary insurer. They didnt have Medicare Part B, which in turn required them to pay out of pocket for those expenses.
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What Doesnt Medicare Part B Cover
Original Medicare Part B doesnt cover everything.2 Some things that arent covered by Medicare include:
- Long-term care .
- Most dental care.
- Acupuncture .
- Hearing aids and exams for fitting them.
- Routine foot care.
If youre wondering whether a test or service is covered by Medicare, you can check here.
Are Medicare Rules Different If I Have Fehb Coverage
Most people who have retiree coverage must enroll in Medicare Part A and Part B when first eligible. If they dont enroll, their retiree plan may pay only a small amount or nothing at all for their care. Medicares rules for you are different, however, if youre a federal retiree. As a federal retiree, if you dont enroll in Medicare, your FEHB plan will act as your primary insurer and wont pay less because you qualify for Medicare.
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The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Medicare Advantage Vs Medigap
People who only have Medicare Parts A, B, and D may incur sizable bills not covered by Medicare. To close these gaps, recipients can enroll in some form of Medigap insurance or in a Medicare Advantage plan .
One important thing to know about Medigap: It only supplements Medicare and is not a stand-alone policy. If your doctor doesn’t take Medicare, Medigap insurance will not pay for the procedure.
Insurance agents are not allowed to sell Medigap to participants of Part C, Medicare Advantage.
Medigap coverage is standardized by Medicare but offered by private insurance companies. According to, Patrick Traverse, founder of MoneyCoach, Mt. Pleasant, S.C.,
“I recommend that my clients purchase Medigap policies to cover their needs. Even though the premiums are higher, it is much easier to plan for them than what could be a large out-of-pocket outlay they might have to face if they had lesser coverage.”
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Do I Need Medicare Part B If I Have Other Insurance
Many people ask if they should sign up for Medicare Part B when they have other insurance or private insurance. At a large employer with 20 or more employees, your employer plan is primary. Medicare is secondary, so you can delay Part B until you retired if you want to.
Keep in mind that both parts of Medicare can coordinate with large employer coverage to reduce your spending. Youll need to decide whether you want to enroll in Part B or delay it until later.
Most people delay Part B in this scenario. Your employer plan likely already provides good outpatient coverage. Part B costs at least $170.10/month for new enrollees in 2022. You can avoid that cost by simply delaying your Part B enrollment until you retire.
Medicare Part B Eligibility And Enrollment
Medicare Part B is available to U.S. citizens and legal residents who fall under one of the following criteria:
- Over the age of 65
- Under the age of 65 with a disability
- Have end-stage renal disease
- Have Lou Gehrig’s disease
If you contributed to Social Security while working and are getting benefits for at least four months prior to turning 65, you will be enrolled in Medicare Part A automatically. You’ll also be enrolled in Part B, but you can choose to decline it since you must pay a separate monthly fee for Part B insurance.
If you do not receive benefits from Social Security, then you’ll need to manually enroll in Medicare Part B. Enrollment begins three months before your 65th birthday and ends three months after the month you turn 65, for a total of seven months.
During this initial enrollment period, you can sign up for any part of Original Medicare. When you enroll before the month you turn 65, coverage begins on the first day of your birth month. If you sign up the month you turn 65 or in the final three months of your enrollment period, your Medicare policy will be effective on the first day of the following month.
If you delay enrolling in Medicare, you may have to wait for a general enrollment period to apply, which runs from Jan. 1 to March 31 each year. Your coverage would start on July 1 following the GEP.
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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.
Where Can I Get Disability For A Veteran
Disability Compensation There is disability compensation offered through the U.S. Department of Veterans Affairs. The compensation is available for veterans who have medical conditions, are disabled, or who have incurred military-related injuries. You will need to supply your medical and military records when applying for the program.
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What Happens If I Decline Fehb Coverage
If you decline FEHB coverage, you would give up the subsidy the government pays toward it, which ranges from a low of about $350 for self-only coverage to $1,000 or more if youre also covering family members. If your family members are covered under FEHB, their coverage would end if you terminate yours.
What The Part B Late Enrollment Penalty
If you do not have creditable coverage after you first become eligible for Medicare Part B, you incur a penalty that you will pay when you eventually do enroll in Part B.
The late enrollment penalty fee amount is a 10 percent increase in your Part B premium for each 12-month period you could have enrolled in Part B but did not.
- For example, if you did not enroll in Part B when first eligible and delayed your enrollment for 14 months , your standard Part B premium amount including your late enrollment penalty would be $187.11 per month.
- This total includes the standard Part B premium of $170.10 per month, plus your late enrollment penalty of $17.01 per month .
If you qualify for a Medicare Special Enrollment Period, you may not be required to pay the late enrollment penalty.
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Your Final Decision On Medicare Part B And The Fehb Program
Throughout our advice we have highlighted specific advantages and disadvantages of enrolling in Medicare Part B in addition to your FEHB enrollment. On the minus side there is one large factorpaying two costly sets of premiums instead of one. For those who pay the higher part B income-tested premiums, this is a very considerable cost, at least $700 a year extra, and for some almost $6,000 extra to join Part B, depending on exact income level. On the plus side there are several factors, including avoiding network restrictions, better coverage for a few services, and having the option to join Medicare Advantage plans and paying only one premium without losing FEHB eligibility.
All of these options and the plans that save the most money within each option vary in details that you can only assess after studying the brochure of several plans. All of them can provide most annuitants substantial annual savings.
We show the extra cost of enrolling in both an FEHB plan and Medicare Part B and show which plans are likely to cost you the least or save you the most by enrolling in Part B. We present the plans in national and local groups, and within each list the plans in order of the lowest cost for self only enrollment in both FEHB and Part B. Some plans cost very little extra for Part B, taking into account both premium and enhanced benefits. These are sometimes the plans that offer the best premium reimbursements, and sometimes not.
How Much Does Medicare Part B Cost
In 2022, Medicare Part B has an out-of-pocket annual deductible of $233 which must be met before medically necessary services will be covered.
In addition to the annual deductible, youll pay a monthly premium. The standard monthly premium for Medicare Part B in 2022 is $170.10.
If youre still working and have an annual income of more than $91,000, your monthly premium may be higher. If youre married and you and your spouse have an annual income of more than $182,000, your monthly premium may be higher.
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Medicare Part B Overview
Part B covers quite a bit of what’s considered as health care: doctor visits, tests, injectable drugs , medical equipment, ambulances, lab work, physical therapy, outpatient surgeries, preventive care and screenings as well as other non-hospital services.
You’re supposed to sign up for Part B when you turn 65 unless you continue to work and rely on health coverage provided by your employer or by your working spouses employer. Enrollment is managed by Social Security and you can enroll in person, online or by mail. If you began receiving Social Security at age 62 on, youll be enrolled automatically in Medicare when you turn 65. But if not, youll receive Medicare coverage only if you complete the necessary forms.
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Benefits Of Medicare Part B
Medicare Part B covers a variety of routine healthcare visits and treatments. If you can afford the premiums, then you may want to take advantage of this program, as it could help offset the cost of ongoing medical care. Depending on your eligibility, you may not have a choice when it comes to Medicare Part B.
However, financial need could help you pay for a portion or all of your monthly premiums. Dont hesitate to contact a representative from your local Social Security office to find out more about your unique situation. Just remember to conduct your own research well ahead of time, so that you dont incur unnecessary late fees in the future.
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Should I Suspend My Fehb Cover To Enroll In Other Coverage
You can suspend your enrollment in FEHB to enroll in Medicare Advantage or other eligible coverage by contacting your agencys retirement system, and providing them documentation that you enrolled. If you do this, youll be allowed to leave your Medicare Advantage plan and return to FEHB. You usually have to wait until Medicares fall open enrollment and FEHBs Open Season to re-enroll in FEHB. You wont have to wait until an enrollment period if your Medicare Advantage plan ends through no fault of your own. In that case, you could re-enroll between 31 days before and 60 days after your Medicare Advantage plan ends. The FEHB coverage would begin the day after the Advantage plan terminates.
FEHB also allows you to suspend your enrollment if you want to use health coverage through Medicaid, Peace Corps, CHAMPVA, TRICARE, or TRICARE-for-Life. You can re-enroll in FEHB if this other coverage ends through no fault of your own. If you cancel your FEHB coverage instead of suspending it, youll never be able to re-enroll.
Although FEHB coverage can be more generous overall than Medicare Advantage or Original Medicare, having additional coverage may not be helpful if you cant afford its premiums. If you qualify for the Medicare Savings Program or Medicaid, you may find your healthcare costs are lower overall if you dont use FEHB.
What You Need To Know About Medicare Parts A B C And D
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There are four parts of Medicare: Part A, Part B, Part C, and Part D. In general, the four Medicare parts cover different services, so it’s essential that you understand the options so you can pick your Medicare coverage carefully.
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Medicare Part B: Doctors And Tests
Medicare Part B covers a long list of medical services including doctor’s visits, medical equipment, outpatient care, outpatient procedures, purchase of blood, mammograms, cardiac rehabilitation, and cancer treatment.
You’re not required to enroll in Part B if you have “” from another source, such as an employer or spouse’s employer. If you don’t enroll and you don’t have creditable coverage from another source, you may have to pay a penalty if you enroll later.
You pay a monthly premium for Part B. In 2022, the standard cost is $170.10, up from $148.50 in 2021. If you’re on Social Security, this may be deducted from your monthly payment.
The annual deductible for Part B is $233 in 2022. Once you meet the deductible, you pay 20% of the Medicare-approved cost of the service, provided your healthcare provider accepts Medicare assignment. But beware: There is no cap on your 20% out-of-pocket expense.
For example, if your medical bills for a certain year were $100,000, you could be responsible for up to $20,000 of those charges, plus the charges incurred under Part A and D umbrellas. There is no lifetime maximum.
Kathryn B. Hauer, MBA, CFP®, EA, a financial advisor with Wilson David Investment Advisors in Aiken, S.C., and author of Financial Advice for Blue Collar America, explains:
On the other hand, you pay nothing for most preventive services, such as diabetes screenings and flu shots, if you receive those services from a provider who accepts Medicare assignment.
