The Ultimate Guide to Medicare Part B


Medicare Part B is one-half of Original Medicare. While Medicare Part B deals with medical insurance, the other half of Original Medicare – Medicare Part A – takes care of hospital insurance. 

Medicare Part B covers medical supplies and services. Anything covered under Medicare Part B has to be medically necessary to treat a patient’s condition. This can include preventive services, durable medical equipment, outpatient care, and ambulance services. 

Medicare Part B also covers intermittent or part-time rehabilitative and home health services. This can include services such as physical therapy.

Are you interested in learning more about Medicare Part B? If so, then continue reading and we’ll walk you through everything you’ll want to know!

Medicare Advantage Plans

If you’re enrolled in a Medicare Advantage plan, then you’d get Medicare coverage from a private health insurance provider. That provider has to be contracted with Medicare.

By law, a Medicare Advantage plan has to offer at least the same amount of coverage as Original Medicare. Some plans will even include additional coverage, such as routine vision, dental, and/or hearing services. They might even include prescription drug coverage that isn’t included in Original Medicare. 

Eligibility for Medicare Part B

People who are eligible for premium-free Medicare Part A are also eligible for Medicare Part B. You simply have to enroll and pay a monthly premium. If you’re not eligible for premium-free Medicare Part A, then you can still get Medicare Part B by meeting the following criteria:

  • You must be at least 65 years old
  • You need to be an American citizen or a permanent US resident for at least five years in a row

It’s also possible for a person to qualify for automatic enrollment in Medicare Part B through disability. 

Are you under the age of 65 and receiving disability benefits from the Social Security Administration? If so, you’ll be enrolled in both Medicare Parts A and B. However, you’ll only be enrolled into the program after receiving disability benefits for two years.

You can also be eligible for enrollment in Medicare Parts A and B before you turn 65 if you have amyotrophic lateral sclerosis (ALS). People who have end-stage renal disease (ESRD) can also enroll before they turn 65. 

When to Enroll in Medicare Part B

If you’re already receiving retirement benefits before age 65, then you’ll likely be automatically enrolled in Original Medicare as soon as you’re eligible. The same can be said if you qualify for Medicare via disability.

If you don’t enroll during your initial enrollment period (IEP), then you can sign up during the annual General Enrollment Period. This period goes from January 1 to March 31. Your coverage would start on the first of July. 

You also might have to pay a late enrollment fee if you don’t sign up when you first become eligible. 

It’s important to remember that your Medigap Open Enrollment Period will start when you’re at least 65 years old and you already have Medicare Part B. This is also the best time to buy a Medicare Supplement insurance plan.

That’s because you have a “guaranteed-issue right” to purchase any Medigap plan. And you can do that without paying a higher premium because of a pre-existing condition. After you enroll in Medicare Part B, make sure that you don’t miss this one-time Medigap enrollment period.  

Delaying Medicare Part B Enrollment

Some individuals might receive premium-free Medicare Part A but will still have to pay a premium for Part B. Because Part B comes with a premium, some people end up not signing up during their IEP. 

If you’re still working, then you should see how your insurance would work with Medicare. If you delay enrollment because you have coverage through your employer, you can sign up later during a Special Enrollment Period without having to pay a late fee. You can enroll in Part B at any time as long as you’re still covered by a group plan based on current employment.

After your coverage ends, you’ll have eight months to sign up for Medicare Part B without having to pay a late fee. 

Medicare Part B Premiums

The premiums for Medicare Part B can change from year to year. The amount can also change depending on your financial situation. For most people, their premium is deducted automatically from their Social Security benefits. 

The standard monthly premium for Part B in 2020 is $144.60. If your income is more than a certain amount, then your premium could be higher than the standard premium. 

Medicare Part B Coinsurance and Deductible Amounts

The annual deductible for Medicare Part B in 2020 is $198. You’ll also have to pay 20% coinsurance for most of the services that are covered. If your doctor accepts assignment for a covered service, then you’ll have to pay the Part B deductible and 20% of the Medicare-approved amount for the doctor’s services. 

When your doctor accepts assignment, they won’t charge you more than the Medicare-approved amount. 

The Value of Knowing About Medicare Part B

Unlike Medicare Part A, the majority of beneficiaries will likely have to pay a premium when they enroll in Medicare Part B. Because of this, it’s important to know how much you can expect to pay and what you can expect to pay for.

It’s also very important that you enroll in the supplement plan that’s best for you.  

If you have any questions or concerns about the right supplement plan for you, then contact us today and see how we can help!