Medicare Part B: Coverage, Cost, and Eligibility
Medicare Part B is your medical insurance and provides coverage for many things that a standard health insurance policy covers.
It pays for two main types of services:
- Medically Necessary Outpatient Services – Medicare covers many supplies and services designed to diagnose or treat various medical conditions. Medically necessary services and supplies must meet the accepted standards of medical practice to be covered by Medicare.
- Preventive Services – Preventing illness or detecting and treating it quickly is typically the best treatment option. Medicare Part B covers preventive care for this purpose.
Examples of what outpatient costs your Medicare Part B medical insurance will pay for:
- Limited outpatient prescription drugs (in most cases, though, this should be covered by a Medicare Part D prescription drug plan)
- Seeing another doctor to get a second opinion before undergoing surgery
- Inpatient, outpatient, and partial hospitalization for mental health purposes
- Durable medical equipment
- Clinical research
- Ambulance services
- Doctor visits
- Physical therapy
- Basic, necessary health services
Examples of what preventative services your Part B insurance will pay for:
- Covid-19 vaccines
- Hepatitis B, flu, and pneumococcal shots
- Diabetes, cancer, and cardiovascular screenings
- Glaucoma tests
- Bone density measurements
- Alcohol misuse and depression screenings
If you did not see what you were looking for on those lists, click here to find out if the service you need is covered.
What is Not Covered?
A few things are not covered by Part B, such as:
- Dental care
- Eye exams
- Hearing aids
- Cosmetic surgery
- Nursing home care
What Does it Cost?
The annual deductible for Medicare Part B in 2023 is $226.00 for all beneficiaries. However, some Medicare Supplement plans will pay for the deductible so that beneficiaries do not have to pay this amount out of pocket.
There is some additional cost-sharing that you should consider. After your deductible has been met for the year, you will typically be required to pay 20% of Medicare-approved costs for healthcare services. Again, if you have a Medicare Supplement, you can get help with these costs to reduce out-of-pocket expenses.
Medicare Part B Premiums
Recipients of Medicare Part B are required to pay a Part B premium. However, the premium does vary based on income. The standard premium for 2023 is $164.90* per month. However, the premiums are a bit more expensive for those with higher incomes. Even with these added Part B costs, most people find that Medicare Parts A and B are well worth the cost. Also, be aware that most Medicare beneficiaries do not have to pay higher premiums than the standard.
Monthly premiums based on beneficiaries who file individual tax returns with annual income:
- Less than or equal to $85,000 – $170.10
- $85,001 to $107,000 – $189.60
- $107,001 to $133,500 – $270.90
- $133,501 to $160,000 – $352.20
- $160,001 to $499,999 – $433.40
- $500,000 to $750,000 – $460.50
Monthly premiums based on beneficiaries who file joint tax returns with annual income:
- Less than or equal to $170,000 – $170.10
- $170,001 to $214,000 – $189.60
- $214,001 to $267,000 – $270.90
- $267,001 to $320,000 – $352.20
- $320,001 to $750,000 – $433.40
- Greater than or equal to $750,000 – $460.50
Who Qualifies for Medicare Part B?
Suppose you are or will be eligible for premium-free Medicare Part A. In that case, you will also be eligible for Medicare Part B as soon as you are eligible for premium-free Medicare Part A.
If you are required to pay a premium for Medicare Part A, such as if you did not pay enough to the Social Security and Medicare system during your working years, then you must meet the following qualifications to enroll in Medicare Part B:
- You must be at least 65 years old
- You must be either a U.S. citizen or a U.S. citizen who is a legal resident and who has been living in the United States for the last five years continuouslyo
Suppose you have received Social Security or Railroad Retirement Board benefits for four months and are eligible for premium-free Medicare Part A and Part B. In that case, you will be automatically enrolled in both. You do have the choice to refuse Part B coverage if you do not want it, however.
Medicare Part B Enrollment
Unlike Medicare Part A — which you can sign up for at any time if you are eligible for premium-free Medicare Part A — you cannot sign up for Medicare Part B at any time. Instead, you can only sign up during the following certain enrollment periods.
- Medicare Part B Initial Enrollment Period: there is a seven-month period when you can sign up for Medicare Part A, Medicare Part B, or both. This time period starts three months before you turn 65, includes the month you turn 65, and lasts for three months after you turn 65. If you wait until the month that you turn 65 or after to sign up for Medicare Part B, though, be aware that your coverage will be delayed and that you could end up with a coverage gap. It is best to sign up for coverage during your Initial Enrollment Period. You could be charged a late enrollment penalty for Medicare Part B if you don’t.
- Medicare Part B General Enrollment Period: in addition to your Initial Enrollment Period, you also have the chance to sign up for Medicare Part B during the General Enrollment Period. This is your opportunity to sign up if you did not sign up during your Initial Enrollment Period and if you don’t qualify for a Special Enrollment Period. The General Enrollment Period is the same for everyone and runs from January 1st to March 31st each year. If you sign up during this period, your coverage will begin on July 1st.
- Medicare Part B Special Enrollment Period: In certain circumstances, you may have a chance to sign up during a Special Enrollment Period. If a group health plan covers you through your employer or spouse’s employer, you are in a continuous Special Enrollment Period. You can sign up for Medicare Part B anytime, as long as you are eligible. If you lose your job or retire and accept your retirement benefits, or if your group health coverage ends for other reasons, you will have an eight-month period during which you can enroll in Medicare.
Ready to Learn More?
Our mission is to inform consumers of their options and help them navigate the plan selection process, and we are proud to work with some of America’s highest-rated insurance providers. Feel free to call our agency for a personalized insurance quote today!
What Medicare Part B Doesn’t Cover