Do I Need Medicare Part B Coverage: How to Decide and What to Do Next
One of the most important decisions you will make is whether or not to sign up for Medicare Part B.
Part B of your medical insurance may or may not be optional depending on your individual circumstances.
This decision can be difficult, but it’s even harder when there are a lot of factors involved. It is vital to work with a licensed and certified Medicare insurance agency to walk you through the entire process of signing up for Medicare Parts A and B.
Here I share some tips on how to decide and what you should do next.
You Need Part B if Medicare Is Your Primary Health Insurance Coverage.
What is Medicare Part B?
Original Medicare is made up of several Parts of Medicare. Medicare Part A coverage (Hospital Insurance) and Medicare Part B (Medical Insurance).
If you have Medicare as your primary health insurance coverage vs secondary health insurance coverage, you need to enroll in Part B. Medicare Part B covers your outpatient medical care, preventive services, and medical equipment and supplies (DME). You generally pay a monthly premium for Medicare Part B coverage.
Once you’re eligible for Medicare and enroll in Part A and/or Part B of Medicare you will receive your red, white, and blue Medicare card showing the effective dates when the coverage begins.
Is Medicare Part B Optional or Mandatory to Buy?
If you’re covered by Medicare, you might wonder if Part B, which covers outpatient care, is optional or mandatory. The answer is that it depends on your situation.
If you’re still working and have creditable health insurance through your employer-sponsored plan, you might not need Part B coverage. However, if you’re retired or self-employed, you’ll need to sign up for Part B when you first become eligible.
We recommend talking with your company’s human resources department to ensure you are following their recommended guidelines.
How Much Does Medicare Part B Cost?
If you have Medicare as your primary health insurance, you may also be eligible for Part B coverage. Part B is optional, however, when it is your primary insurance, Medicare Part B covers outpatient services. Part B provides the needed benefits related to doctors’ office visits, and specialists and covers some of your out-of-pocket expenses.
The Medicare Part B insurance premium is $170.10 per month in 2022 and usually increases annually. If you enroll in Part B during your Initial Enrollment Period, you will pay the standard premium amount. If you delay enrolling in Part B until after your Initial Enrollment Period, you may have to pay a higher premium, depending on when you enroll and if you qualify for a special enrollment period.
If you have Medicare and Medicaid, your state may help pay your Part B premium. You will still need to pay any deductibles, coinsurance, and copayments. If you buy a Medicare Supplement plan, these plans can cover the gaps Medicare Part B doesn’t cover.
Can I Pay the Medicare Part B Premium through my Social Security Check Electronically?
Yes, you can pay the Medicare Part B premium through your Social Security check electronically. If you have questions about this process, please contact your local Social Security office. One of our Medicare Insurance Agents is also here to answer any questions you may have.
What Common Scenarios make Medicare my Primary Health Insurance?
There are a few common scenarios in which Medicare will be your primary health insurance:
– If you’re over 65 and you’re receiving retirement benefits from Social Security or the Railroad Retirement Board, you’re automatically enrolled in Part A and Part B.
– If you have a disability, you may be eligible for Part A and Part B.
– If you have End-Stage Renal Disease, you’ll need to enroll in Part A and Part B.
In each of these cases, you’ll need to decide if you want to enroll in Part B. If you’re not sure, you can speak with a Medicare representative to get more information.
Medicare Part B Eligibility Requirements?
- People who are 65 years or older and are US citizens or permanent legal residents
- People under 65 years old with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease
To be eligible for Medicare Part B, you must first be enrolled in Medicare Part A. You can sign up for Part B during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your birthday. You can also sign up for Part B during the General Enrollment Period, which runs from January 1 to March 31 each year.
It is important to ensure you also enroll in your Part D Medicare prescription drug plan. Medicare beneficiaries can sign up for Part D coverage either in a standalone plan or when they join a Medicare Advantage plan.
How do I decide if I need Medicare Part B?
There are two main factors to consider when deciding if you need Medicare Part B:
- whether you plan on actively working after age 65 and
- whether you or your spouse have group health insurance through an employer.
If you’re still working and have group health insurance, you likely don’t need Medicare Part B. This is because your group health insurance will be the primary payer of your medical bills, and Medicare will be the secondary payer.
If you’re retired or self-employed, you’ll need to decide if you want to enroll in Medicare Part B. You may not need to if you have other health insurance that is just as good as or better than Medicare.
What are the benefits of the Medicare Part B Insurance Plan?
Medicare will pay for a wide range of services, including:
- Includes Preventive care
- Doctor’s visits
- Outpatient care
- Mental health services
- Some home health services
Part B also covers some clinical research and durable medical equipment. You are required to pay a premium for Part B coverage. If you enroll in a Medicare supplement plan you will also pay a premium for these plans sold by private insurance companies.
You Need to Enroll in Medicare Part B Coverage to Be Eligible for Medicare Supplement Plan
Are Medigap Plans Part of Original Medicare?
No, Medigap plans are not part of Original Medicare but rather work alongside Medicare. You must enroll in Part A and Part B of Medicare to be eligible for a Medigap plan. When you sign up for a Medicare plan you have three options.
- Sign up for Original Medicare
- Sign up for Original Medicare and buy a Medigap Plan
- Sign up for a Medicare Advantage Plan
You will need to make these decisions when you first become eligible for Medicare. This decision you make will have a lasting impact on your overall health care coverage. Ensure you take with an independent Medicare insurance agent when you are first eligible for Medicare, so they can go over the different Medicare options available to you.
How to Enroll in Part B to Be Eligible for Medicare Supplement Insurance
If you’re enrolled in Medicare Part A and you want to be eligible for a Medicare Supplement plan, you’ll need to enroll in Part B of Medicare first.
Here’s how you can do it:
- You can enroll in Part B online through the Social Security Administration website.
- You can also enroll by calling the Social Security Administration at 1-800-772-1213.
- If you’re already receiving benefits from Social Security or the Railroad Retirement Board, you can enroll in Part B by contacting your local Social Security office.
Medicare beneficiaries can buy a Medigap plan through Integrity Now Insurance Brokers. A Medicare supplement insurance agent is your best option for purchasing a Medigap plan as they obtain Medicare supplement quotes from the available insurance companies in your state.
Which Medigap Plans are the Most Popular?
There are 10 different Medigap plans available to Medicare beneficiaries, each with its own set of benefits. But which of these plans are the most popular?
The three most popular Medigap plans are Plan F, Plan G, and Plan N. All three of these Medicare supplement plans offer comprehensive coverage, but they differ in terms of cost and other features.
- Plan F was the most popular Medigap plan up until January 1, 2020, as it covers 100% of all Part A and Part B Medicare out-of-pocket costs. This includes deductibles, copayments, and coinsurance. Plan F is also the most expensive Medigap plan, and is no longer accepting new Medicare beneficiaries who turn 65 after January 1, 2020.
- Plan G is the most popular Medigap plan for all new Medicare beneficiaries who qualify for Part A coverage and Part B after January 1, 2020. It covers all of Medicare’s out-of-pocket costs except for the Medicare Part B deductible. Plan G is a great option for people who want comprehensive coverage that allows them to see any doctor and medical facility that accepts Medicare patients.
- Plan N is the second most popular Medigap plan. It covers most of Medicare’s out-of-pocket costs, except for the Medicare Part B deductible, copayments, and coinsurance. Medigap Plan N also does not cover excess charges from doctors who do not accept Medicare assignment. It is a good option for people who want coverage for the major out-of-pocket costs but don’t want to pay for the extras.
Enrolling in a Medigap plan is a great way to get comprehensive coverage and peace of mind. If you’re not sure which plan is right for you, talk to one of our Medicare specialists.
Don’t Forget to Enroll in Standalone Medicare Part D Prescription Drug Coverage with your Medigap Plan.
Don’t forget to enroll in a standalone Medicare Part D Prescription Drug Plan with your Medigap Plan. A Medicare Part D plan is the best way to get prescription drug coverage.
Medicare Part A generally covers medications while admitted into a hospital. Medicare Part B pays for medications administered by a doctor at their office. However, Part D is required to provide coverage when picking up medications at your local pharmacy.
You Need to Enroll in Part B to Be Eligible for A Medicare Advantage Plan (Medicare Part C)
How Do I Find a Medicare Advantage Plan?
You can find a Medicare Advantage plan in several ways:
- By visiting the Medicare website
- By contacting a Medicare Advantage plan provider
- By contacting a Medicare Advantage plan insurance broker
Each of these methods has its own set of benefits and drawbacks, so it’s important to choose the one that’s right for you. By working with Insurance Now Insurance Brokers we are an independent insurance agency. This allows us to represent our client’s best interest when shopping around for Medicare quotes. We are not limited to only providing insurance quotes for a single insurance company.
Is a Medicare Advantage Plan Part of Original Medicare?
No, a Medicare Advantage Plan is not part of Original Medicare. Medicare Advantage Plans are offered by private insurance companies that contract with Medicare. If you have a Medicare Advantage Plan, you’re still in the Medicare program. You’ll still have to pay your Medicare Part B premium.
However, when you sign up for a Medicare Advantage plan you give up your Original Medicare benefits and transfer health decision needs over to the private Medicare Advantage company.
Most Medicare Advantage plans are HMO plans and require you to only see their medical group of doctors and facilities. Doctors who accept Medicare but are not within the medical group are excluded from coverage.
Can I Sign Up For a Standalone Part D Plan If I Enroll in a Medicare Advantage Plan?
No. You can’t enroll in a standalone Part D plan if you’re enrolled in a Medicare Advantage Plan. Medicare Advantage Plans (like an HMO or PPO) offer prescription drug coverage that meets or exceeds the standards set by Medicare. If you’re enrolled in one of these plans, you must accept the Part D plan that is included under your Medicare Advantage plan.
If a Medicare beneficiary attempts to enroll in a standalone Part D plan, they will automatically be disenrolled from their Medicare Advantage plan and returned back to Original Medicare.
Do I Need to Enroll in Medicare Part A and Medicare Part B to be Eligible for CHAMPVA?
Yes. You may need to enroll in both Medicare Part A and Part B to be eligible for CHAMPVA once you turn 65 and become eligible for Medicare. Part A is usually free for people who have worked and paid Medicare taxes for at least 10 years. Part B has a monthly premium that is deducted from your Social Security check.
CHAMPVA members do not need to purchase Medigap plans, Medicare Advantage plans, or Part D coverage. Your CHAMPVA coverage will become secondary and provides the needed creditable Part D coverage.
Do I Need to Enroll in Medicare Part A and Part B to be Eligible for TRICARE for Life
Active-duty service members and their families who are enrolled in TRICARE Prime or TRICARE Select may delay enrolling in Medicare Part B without incurring any late penalties. However, you must enroll in both Medicare Part A and Part B before you become eligible for TRICARE for Life.
Do I Need Medicare Part B if I Have Other Insurance?
If you’re still working and have group health insurance through your employer, you may not need to sign up for Medicare Part B right away. In most cases, you can delay Part B enrollment until you retire without having to pay a late enrollment penalty.
Do I need Medicare Part B if I’m a Veteran?
If you’re a veteran, you may be wondering if you need to enroll in Medicare Part B. The answer depends on a few factors, including whether you’re eligible for Veterans Affairs (VA) benefits and whether you have other health insurance coverage.
Here’s what you need to know about Medicare Part B and veterans:
- Veterans who are eligible for VA benefits don’t need to enroll in Medicare Part B.
- Veterans who aren’t eligible for VA benefits may still be able to get health care coverage through the Veterans Health Administration (VHA).
- Veterans who have other health insurance coverage may not need to enroll in Medicare Part B, but they should check with their insurance provider to see if their coverage includes Medicare-covered services.
- The Department of Veterans Affairs recommends all Veterans enroll in Medicare Part B as VA health coverage is not considered creditable for Part B of Medicare.
If you’re a veteran and you’re not sure if you need to enroll in Medicare Part B, the best thing to do is to contact the Veterans Affairs office nearest you. They can help you figure out what coverage you’re eligible for and how to enroll.
The owner of Integrity Now Insurance Brokers is also a disabled Veteran and is able to help you in making this decision.
Most Common Mistakes Regarding Part B Medicare Benefits
There are a few common mistakes that people make when it comes to enrolling in Part B Medicare benefits. Here are a few of the most common mistakes to avoid.
Not enrolling in Part B when first eligible.
Part B is not automatically enrolled when a person turns 65. You have to actively sign up for it. If you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty.
Failing to understand the difference between Part A and Part B.
Part A covers hospitalization while Part B covers doctor’s visits. Many people think that Part A covers all medical expenses, but that’s not the case. It’s important to understand the difference between the two so that you can make sure you’re enrolling in the right coverage.
Not enrolling in Part B if you’re still working.
Just because you have a job doesn’t mean you’re not eligible for Part B coverage and that Medicare is not better than your current employer-based coverage. In fact, you may be able to get a subsidy from your employer to help pay for the premiums. Even if you’re not eligible for a subsidy, it’s still a good idea to evaluate the two coverages and see which plan is better for you.
Failing to enroll in Part B during a special enrollment period.
If you miss your initial enrollment period, you may still be able to sign up for Part B during a special enrollment period. This is usually available if you’re losing other health coverage, such as through a job loss or retirement.
Not understanding how Part B works with other insurance coverage.
Often Medicare beneficiaries only sign up for Medicare Part A as they are not aware they need Part B and Part D insurance coverage.
Not signing up for a Medicare Supplement Plan during your guaranteed issue period.
If you don’t sign up for a Medicare Supplement Plan during your guaranteed issue period, you may have to pay more for your plan later on. Guaranteed issue periods are a time when insurance companies can’t refuse to cover you or charge you more because of pre-existing conditions.
Signing up for the wrong Medicare Advantage plan.
If you’re not careful, you can easily end up signing up for the wrong Medicare Advantage plan. There are a lot of different plans out there, and it can be hard to know which one is right for you. If you sign up for a plan that doesn’t cover the services or prescription drug coverage you need, or that has high out-of-pocket costs, you could end up paying a lot of money out of pocket for your healthcare.
Avoiding these common mistakes can help you get the most out of your Part B Medicare enrollment. If you have any questions about your coverage, be sure to talk to our insurance agent for help.
Scenarios in Which you Can’t Delay Part B Without Facing Lifetime a Medicare Part B Penalty Include
If you’re still working and have health insurance through your job or your spouse’s job, you can delay Part B without facing any penalties. But there are a few scenarios in which you can’t delay Part B without facing lifetime penalties, including:
- You only have VA coverage and decide to obtain coverage outside of the VA at a later date requiring you to sign up for Part B at a later date.
- Your place of employment consists of less than 20 employees
- You are part of a cost-sharing program, rather than traditional health insurance
How do I compare Medigap Plans vs Medicare Advantage Plans?
There are two main types of Medicare plans Medigap and Medicare Advantage.
When exploring these two plan types ensure you ask our insurance agents the following questions:
- How does each program work
- What are the advantages and disadvantages of each program
- How best to obtain your dental, vision, and hearing aid coverage
- Can I see my must-have doctors
- Are my prescriptions covered
- What happens if I travel out of state
- Which plan is best for snowbirds
- What are your health care needs today and in the future
In having this discussion you may find that one health plan option may cover your Medicare needs more than another.
What is the Part B Late Enrollment Penalty?
If you didn’t sign up for Part B when you were first eligible, you may have to pay a late enrollment penalty.
Your monthly premium for Part B may go up 10% for each 12-month period that you could have had Part B coverage in place, but didn’t sign up for it.
Depending on when you seek to enroll in Medicare Part B, you may have to wait a few months for the General Enrollment Period begins to sign up for Part B.
What are some other things to consider when deciding whether or not to Apply for Medicare Part B?
A few things to consider about signing up for Medicare Part B may include the following:
- If you’re still working and have health insurance through your job, you may not need to sign up for Part B right away. You can wait until you retire or lose your job-based coverage.
- If you have other health coverage, like a retiree health plan from a former employer, you may not need to get Part B right away. In some cases, you may be able to delay Part B without paying a penalty.
- You may already have coverage that’s as good as or better than Part B. If you have a Health Savings Account (HSA) or a Medical Savings Account (MSA), you may want to keep that account and not sign up for Part B.
- If you have coverage through the Veterans Affairs (VA) health care program you may not need to sign up for Part B.
Do I Need Medicare Part B If I Am Still Working?
If you are still working and have health insurance through your employer, you may not need to enroll in Medicare Part B. You can delay enrolling in Part B without having to pay a penalty, as long as you have health insurance through your employer.
Should I Drop My Employer Health Insurance And Go On Medicare?
It’s a common question for those nearing retirement age: should I drop my employer’s health insurance and go on Medicare? The answer isn’t always simple, as it depends on a number of factors. Here are a few things to consider when making your decision:
- Whether you are still working and whether your employer offers health insurance
- Whether you are eligible for Medicare
- Whether you need to enroll in Medicare Part B
- The cost of your employer’s health insurance vs. the cost of Medicare
Making the decision of whether to drop your employer’s health insurance and go on Medicare is a personal one. However, understanding the pros and cons of each option can help you make the best decision for your situation.
Do I Need Medicare Part B If I Have Retiree Insurance from my Employer?
If you’re retired and have health insurance through your former employer, you might not need to sign up for Medicare Part B. In some cases, your employer’s insurance can act as a supplement to Medicare. In other cases, you might be able to delay signing up for Part B without penalty.
Why Should I Delay My Part B if I Have Creditable Coverage?
There are a few reasons why you might want to delay enrolling in Medicare Part B if you have creditable coverage. One reason is that you may not need the extra coverage. If you’re still working and have health insurance through your employer, you may not need Part B.
Another reason to delay Part B is that you may save money on your premiums. If you wait to enroll in Part B until you’re no longer covered by a creditable plan, you won’t have to pay a late enrollment penalty.
Is Part B Worth it?
Medicare Part B is a voluntary insurance program that helps cover medical expenses. It is not required, but many people choose to enroll in Part B because it can help pay for doctor visits, outpatient care, and preventive services. Part B is usually worth the cost if you need regular medical care.
With the changing environment in how our healthcare needs are being met, it is more common to have a major surgery done through outpatient services. As outpatient surgeries fall on Medicare Part B, without this part of Medicare individuals can face hundreds of thousands of dollars in medical bills.
Integrity Now Insurance Broker is a full-service Medicare insurance agency. We offer our services throughout California, Arizona, Nevada, Washington, Texas, and all of the 50 states.
Give us a call and let us help you with a Medigap or Medicare Advantage plan.