Original Medicare has two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part B covers medical supplies and services that are medically needed to treat your illnesses and/or injuries. This includes but is not limited to:
- Durable medical equipment
- Preventive services
- Ambulance services
- Outpatient care
It will also cover intermittent or part-time rehabilitative or home health services. Physical therapy is one of those services it covers if it’s ordered by a doctor to treat the condition you have.
Medicare Part B includes preventive services that cover:
- Diabetes screenings
- Cardiovascular screenings
- Cancer screenings
- A one-time “Welcome to Medicare” preventive visit
- Flu and hepatitis B shots
- And much more
Please check the Medicare handbook, “Medicare and You“, if you want a full list of preventive services that Medicare Part B covers.
A Medicare Advantage plan covers both Medicare Part A and Part B through a Medicare-approved, private health insurance company. Note that Medicare advantage plans have to offer at minimum, the same level of coverage as Original Medicare. And some Medicare advantage plans offer more coverage than Original Medicare like vision, hearing, routine dental and prescription drug coverage.
Are you eligible for Medicare Part B?
How do you know you are eligible for Medicare Part B? If you are eligible for premium-free Medicare Part A, then you are eligible for Part B (medical insurance). When you enroll in Medicare Part B, you must pay a monthly premium.
What happens if you are not eligible for premium-free Medicare Part A? Then you must meet the following qualifications below:
- You have to be 65 years old or older
- You must be a permanent resident in the United States for at least five consecutive years or a United States citizen.
If you have a disability, it can qualify you for automatic enrollment in Medicare Part B. If you are getting Railroad Retirement Board (RRB) or Social Security disability benefits and you are under 65. Then you qualify for automatic enrollment in Medicare Part A and Part B after 24 months of disability benefits.
If you have ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease). Then you will generally be eligible for Medicare Part B before age 65.
How do you know when to enroll in Medicare Part B?
Do you qualify for Medicare through disability or are you currently receiving retirement benefits before age 65? Then, your enrollment in Medicare Part A and Part B will normally be automatic as soon as you become eligible.
You can sign up during the annual General Enrollment Period, if you do not qualify for a special enrollment period or did not enroll during your IEP. The General Enrollment Period starts January 1 and ends March 31. Your coverage will start on July 1 the same year you enrolled.
Here’s how you can apply if you are not qualified for automatic enrollment:
- Through the Social Security website.
- Calling 1–800–772–1213 (TTY users 1–800–325–0778) Monday — Friday, From 7AM to 7PM.
- In person at a local Social Security office
When is the best time to buy a Medicare Supplement Insurance Plan? The best time to buy a Medicare Supplement Insurance Plan is during your six-month Medigap Open Enrollment Period. This period begins once you have Medicare Part B and are 65 years or older. During this enrollment period, you will have a “guaranteed-issue right” to purchase any Medigap plan without medical underwriting. You also will not have to pay a higher premium due to a pre-existing condition. Make sure you do not miss this enrollment period for Medigap once you enroll in Medicare Part B.
What happens if you delay your Medicare Part B enrollment?
Medicare Part B comes with a monthly premium that most people have to pay. Paying a monthly premium is why some people choose not to sign up to Medicare Part B during their initial enrollment period. You should only postpone signing during your IEP if an employer group plan (either your own or spouse’s) covers you.
You can also avoid paying a late enrollment penalty if you already have current employment health coverage. Avoid paying this penalty by signing up during a Special Enrollment Period. You have an 8-month period to sign up during a special enrollment period for Part B right after your employer health coverage or employment ends. Also, if a group plan based on current employment covers your health insurance, you can still enroll in Medicare Part B at any time. If you’re still working, find out with your health benefits administrator to know how your insurance would pair with Medicare.
Are COBRA and retiree coverage considered health based coverage based on current employment? No, they are not and you would not be qualified for a special enrollment period solely on those coverages. Your 8-month Part B special enrollment period will start after your group or current employment plan ends, regardless of COBRA. So, do not wait until your COBRA coverage ends after your employer coverage ends to sign up for Medicare Part B.
The amount you need to pay for Medicare Part B premiums
Below is the standard monthly Part B premium rates that may change from year to year. The amount you will have to pay is situation-dependent and can vary from person to person. Usually, the premium will automatically deduct from your Social Security benefits.
$144.60 is the standard Monthly Part B premium in 2020.
However, your premium could be higher than this standard if your income is above a certain amount. Whatever your income level is, determines your premium.
Check below to see more details about the Medicare Part B premium.
Are you currently getting any of these benefits?
- Federal Retirement
- Social Security
- Railroad Retirement Board
If you are receiving any benefits just stated, then your Part B premium will be deducted from your monthly benefit. If not, expect a bill in the mail every 3 months for your Medicare Part B premium.
This chart below shows the 2020 monthly premium amounts you had to pay for Medicare Part B. Your reported income will determine how much you have to pay. And the amount you have to pay could change from year to year. If you did not enroll in Medicare Part B when during your Initial Enrollment Period, you could pay a late enrollment penalty. You could pay a higher premium up to 10% for each 12-month period that you did not enroll in Part B when you were eligible.
| 2020 Medicare Monthly Premium | ||
|---|---|---|
| Here is what you pay | If your yearly income is | |
| If you filed an individual tax return | If you filed a joint tax return | |
| $144.60 | $87,000 or less | $174,000 or less |
| $202.40 | $87,001 – $109,000 | $174,001 – $218,000 |
| $289.20 | $109,001 – $136,000 | $218,001 – $272,000 |
| $376 | $136,000 – $163,000 | $272,001 – $326,000 |
| $462.70 | $163,001 to less than $500,000 | $326,001 to less than $750,000 |
| $491.60 | $500,000 or more | $750,000 or more |
| You pay | If you file a separate tax return than your spouse and you are married. And your yearly income is: | |
| $144.60 | $87,000 or less | |
| $462.70 | $87,001 to less than $413,000 | |
| $491.60 | $413,000 or more | |
What you have to pay for Medicare Part B coinsurance and deductible
In 2020, $198 is the annual deductible for Medicare Part B. Also, you will have to pay a 20% coinsurance for various covered services. In total you would pay 20% coinsurance along with the annual Part B deductible. You would have to pay coinsurance if your doctor or health care provider accepts assignment for a covered service. This means that your doctor will not bill you more than the amount agreed upon by Medicare. However, you will still have to pay the cost-sharing.
You can start comparing and contrasting Medicare plans in your area if you enter your zip code in the form on this page. Also, you can reach out to us as our information is above this article.
If you have pre-existing conditions, then study a specific plan’s official plan documents to see how the coverage will handle it. They may exclude your coverage, prevent you from approval, or limit your coverage. Therefore, you must check to see because exclusions or limitations of coverage vary from plan to plan.
If you want more information about pre-existing conditions and the rules, then contact the plan. Copayments, restrictions, and limitations may apply. However, plan benefits and rules may change on January 1 of every year.