What You Should Know About Medicare Part B

What You Should Know About Medicare Part B

If you or someone you know is reaching Medicare eligibility soon, it’s important to know what Medicare Part B is and how it works. Medicare insurance can initially feel complicated, but understanding Part B can help alleviate some confusion.

Here’s what you should know about Medicare Part B.

What is Medicare Part B?

Medicare Part B is a part of what is referred to as “Original Medicare” or “Traditional Medicare.” Original Medicare consists of two different parts: Medicare Part A and Part B. The federal government is responsible for managing these two parts.

Part A helps cover your inpatient care, like room and board costs, skilled nursing facility stays, home health care, and more. Part B helps cover your outpatient care, which we will discuss a bit later.

You must be familiar with these two parts as they essentially act as the foundation for your Medicare insurance. In fact, without Medicare Part A and Part B, you will not be able to enroll in other supplemental coverage, including a Medigap or an Advantage plan.

Now, let’s take a look at what Part B charges.

How much does Medicare Part B cost?

The costs associated with Part B can be confusing, especially when it comes to Part B charges. Everyone must pay a monthly premium for Part B. The only people who don’t pay are those who qualify for Medicaid. In 2022, the standard Part B premium is $170.10. This amount will decrease to $164.90 in 2023. 

However, you may have to pay more for Part B if your income is above a certain amount. This is known as an Income-Related Monthly Adjustment Amount (IRMAA) charge. Social Security determines if you qualify for an IRMAA charge by referring to your IRS tax return from two years ago. So, for example, Social Security will refer to your tax return from 2021 to decide if you will pay more for your Part B premium in 2023.

When should you sign up for Medicare Part B?

Most people are first eligible for Medicare around age 65 during their Initial Enrollment Period (IEP). This period begins three months before your 65th birthday month and ends three months after. During this time, you can enroll in Medicare Part A and Part B through Social Security and avoid late enrollment penalties.

If you have other creditable coverage, such as large employer insurance, you can delay your Medicare enrollment past 65. However, be sure to verify that you have creditable coverage first, so you don’t get hit with a late enrollment penalty later.

What does Medicare Part B cover?

As mentioned earlier, Part B helps cover your outpatient care. This includes a wide range of medical services, like doctor visits, lab work, surgeries, preventative services, certain vaccinations, and more.

It’s important to note, however, that Part B typically only covers “medically necessary” services. Medicare defines medically necessary as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” However, in most cases, if you are working with a provider to address a health condition, that condition should be covered by Medicare.

You’ll also want to keep in mind that Part B only covers 80% of Medicare-approved services. You are responsible for the leftover 20%. If you receive medical care often or expensive care, this 20% can add up quickly. Fortunately, you can enroll in supplemental coverage, either a Medigap or an Advantage plan, to help cover these costs.

What does Medicare Part B NOT cover?

Although Part B helps cover a wide variety of medical services, it does not cover everything. As discussed above, Part B does not usually cover services that are not considered “medically necessary.”

Additionally, Part B typically does not cover routine dental, vision, and hearing services. This surprises many people, so it’s helpful to know this information as you transition to Medicare. Many people enroll in stand-alone insurance plans to help cover these costs if needed. Others decide to pay out-of-pocket instead.

Now, Part B can help pay for dental, vision, and hearing services if the services are related to another health condition. For example, if someone with oral cancer needs to receive dental work as part of their cancer treatment, Medicare would help with this.

Final Thoughts

Part B is an essential component of your health insurance through Medicare. Knowing how it operates will assist you in navigating the world of Medicare. Although this information can seem overwhelming at first, taking the time to understand it will help ensure you receive the coverage you need.