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Medicare Part B: Medical Insurance

 

Medicare Part B (medical insurance) is part of what is commonly called “Original Medicare” and helps pay for some services and products not covered by Part A, generally on an outpatient basis. Medicare Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.

Part B coverage includes:
 

  • Physician and nursing services

  • Clinical research

  • Ambulance services

  • Durable medical equipment (DME)

  • Mental health

    • Inpatient

    • Outpatient

    • Partial hospitalization

  • Getting a second opinion before surgery

  • Limited outpatient prescription drugs

  • X-rays, laboratory and diagnostic tests

  • Influenza and pneumonia vaccinations

  • Blood transfusions and renal dialysis

  • Outpatient hospital procedures and limited ambulance transportation

  • Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor’s office.

Medication is covered under Part B only if it is administered by the physician during an office visit.

 

Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.[6]

Gaps in Medicare Part B

 

  • Part B Monthly Premium – Standard Premium for 2015 is $104.90

 

You pay a Part B premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

 

For Information on Income adjustments see page: What Medicare Cost? 

 

  • Part B Deductible $147.00

How to enroll in Medicare Part B?

 

Anyone who is eligible for “premium free” Part “A”, residing in the United States (except residents of Puerto Rico) automatically enrolled in Part B.  Since Part B is voluntary program which requires the payment of a monthly premium, those individuals who do not want coverage may refuse enrollment. A typical example of this is – as mentioned- if the individual is still working and eligible for medical insurance through the employer health plan or a spouse of an individual and thus eligible to participate in that spouses employer group health plan.

 

 

Who is eligible for Medicare Part B?

 

  • Anyone eligible for Free Medicare Part A is eligible for Part B

  • Persons age 65 or over who is not entitled to premium-free Part A must meet the following:

    • Must be a U.S. resident, and

    • either a citizen, or an alien who has been lawfully admitted for permanent residence with 5 years continuous residence in this country at the time of filing.

 

Individuals who are not eligible for automatic enrollment, or who previously refused Part B, or who terminated their Part B enrollment, may enroll (or re-enroll) in Part B only during prescribed enrollment periods.

 

Find More information on specific Medicare Enrollment periods

Generally speaking Medicare Part B pays 80% of covered Medical expenses and thus the remainder is the responsibility of each individual. These are commonly referred to as the “Gaps” in Medicare. The typical Medicare Supplemental insurance Plan, a.k.a. Medigap will help pay some or all of these cost that are left behind.

For help understanding Medigap plans request a consultation or get quotes at either of the buttons that will get these for you. One of our Medicare Insurance specialist will walk you through all of your options.

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