Part B Cover?
Medicare Part B is viewed by most as your Doctors office visit coverage. While this is very true you will find its riches benefit happens when you have an outpatient surgery need such as knee replacement surgery. Unlike a visit to your primary care Doctor which may cost a few hundred dollars per visit, outpatient surgery could cost tens of thousands.
Part B coverage has an abundance of Medicare insurance benefits packed into it. Some of these benefits include the following:
- Clinical Research
- Yearly wellness visit
- Preventive care
- Flu shots
- Prostate screening
- Mental Health
- Outpatient services
- Doctor’s visits
- Lab testing
- Home health care
- Ambulance rides
- chiropractic care
- Cancer screening
- Radiation or chemotherapy for cancer
- Bone Density
- MRI, CT SCAN, XRAY
- Durable medical equipment
- Dialysis for failing kidneys.
While Part B is not a required coverage that you are required by law to obtain, it is definitely a coverage you will not regret having in place. If you want to sign up for a Medicare supplemental policy or a Medicare Advantage plan, you will be required to first sign up for both Part A and Part B coverage under Original Medicare. Without having both of these coverages in place you will not be able to take advantage of these two programs.
While most preventive coverages are covered under Part B, the shingles shot is covered under your Part D prescription drug coverage. It is important to understand what coverage part each particular drug falls under, so you are not surprised later when a bill arrives.
What does Medicare cover in terms of costs under Part B? In general Medicare will pick up 80% of the approved costs after you first pay the annual deductible. This means without a Medigap plan or a Medicare Advantage plan you are responsible for a minimum of 20% of the medical bill in addition to any copays and/or deductibles.
How Much does Medicare Part B cost?
Your Part B insurance premium are based on your prior 2 years annual household income. Most Medicare beneficiaries will be responsible to pay the standard minimum monthly cost which is determined by the government each year. In 2022, the base rate for Part B is $170.10 per month.
You can find a chart showing the costs based on your income bracket on our Medicare costs page. If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.
You have several choices on how to make your insurance premium. The most common is for Medicare beneficiaries to pay their Part B premium through automatic deduction from their Social Security check each month.
Pay your Part B premium through the US Mail on a quarterly basis is another preferred method, for those who like to receive an actually bill.
If you are like me, my family likes to earn points on our credit card. If this is also your preferred method, at the bottom of your quarterly invoice you received from Medicare, you can select pay by credit card. Simply complete the lower portion of the invoice and mail it into the Medicare for processing.
As credit cards do expire you may not want to be responsible to ensure your payment is not missed and coverage is then cancelled. A great option we also recommend is signing up for electronic payment through your bank account. Medicare will deduct your premium payments monthly from a checking or savings account.
Again the most popular payment option would be to have your monthly premium deducted from your Social Security check.
Why is my Medicare Part B premium more than the standard rate of $170.10
The Social Security Administration (SSA) – or the Railroad Retirement Board, if that applies to you – determine how much your monthly Part B premium will be. The total premium amount is calculated based on the taxes you filed from 2 years ago.
If your income falls into one of the higher-income categories based on your tax return from 2 years prior to obtain Part B coverage, in most cases you’ll pay more than the standard Medicare Part B premium.
The additional amount you would need to pay is referred to as the Income Related Monthly Adjustment Amount, or (“IRMAA”).
Here is a chart of Medicare Part B premiums for 2020, including IRMAA amounts, if applicable. Please note that your actual premium may be different depending on your individual circumstances.
Do I have to pay the higher cost
associated with IRMAA forever ?
IRMAA is factored into your monthly Part B premium based on your taxable income from 2 years ago. Meaning if you are applying for Medicare Part B in 2020 they will look at your 2018 tax records.
Now if we fast forward to 2021 and you have been enrolled into the plan for a year the Social Security Administration should revise your ARMAA calculation automatically based on your 2019 tax year. If your income went up then you could pay a higher amount and if your income went down then you could pay a lower amount.
If your income went down and you believe you should be paying less towards your Part B premium, we recommend that you first look at the current year IRMAA surcharge calculations. Then we recommend you review your tax documents you filed from 2 years prior.
If after reviewing both of these items and you still you should be paying less then what the SSA is charging you for Part B coverage you can complete following form SSA44 “Medicare Income-Related Monthly Adjustment Amount – Life Changing Event” and submit it into SSA appeal department.
Below is a link to the SSA44 Form. Once competed you will need to either mail or drop the form off to your local SSA office for processing.
How Do I Sign Up for Medicare Part B?
Medicare beneficiaries who are already collecting their Social Security income benefits at age 65 will not need to take steps into enrolling into Part A or Part B as it will happen automatically for you. It is recommended that you call your local Social Security office to ensure they do enroll you without anything needed on your end. This is simply a peace of mind phone call.
You should receive your Medicare card showing you are enrolled into Part A and Part B as there will be an effective date next to each of these two parts. Because you are already taking Social Security benefits you can expect to receive our new Medicare card in the mail 1 to 2 months before your 65th birthday.
If you are not already taking Social Security benefits prior to the age of 65, you will need to apply for Medicare Part B 90 days prior to turning age 65.
Depending on your preferred method of communication you can apply for Medicare Part B by doing any of the following:
- Over the phone
- In person at your local Social Security office.
Once you have provided all of the needed information and have completed the needed application you can expect to receive your Medicare cards in the mail in about 2 to 3 weeks.
The sooner you begin the process to complete your Part B enrollment the less stress you will experience in the end. Planning ahead when it comes to enrolling into Medicare is the key to your success.
Signing up for Part B has never been easier with the number of options that are at our disposal. If you will not continue to be enrolled into an employers plan from age 65 and beyond It will be important for you to enroll into Part B coverage during your initial enrollment period. If you do not have creditable coverage in place at the age of 65 or older you will be obligated to pay penalties that will last a lifetime.
For more information on each of these application options, visit our Apply for Medicare page.
Does Medicare Part B Cover Outpatient Services?
When it comes to Original Medicare in general the Doctor needs to come to a medical decision on your case this your outpatient services are classified as “medically necessary”. Most of the time one your Doctor is able to determine that your medical condition requires a procedure that is medically necessary it will be approved almost instantly.
Each time you to visit your Doctor either in person or virtually, your Doctor is creating a document trail however short or long that it needs to be outlining any and all of your specific medical needs. Not only are they covering themselves from any liability concerns they may face, they are putting together the needed information on how to fix your medical condition
In the off chance Medicare disagrees with your Doctor’s recommendation on your medical condition and it meeting the guidelines of being medical necessity, Medicare has the right to request additional documentation to show your case is truly needed.
However, in our experience, as long as you are enrolled in Original Medicare with a Medigap policy, it is very rare for a claim to be slowed down or even decline.
What Doesn’t Origianal Medicare Part B Cover?
While Part B is super broad in what it does cover like any insurance policy there are limitations or that specific coverage you might be looking for might be covered under a different Medicare Part (like Part A or Part D) or you may need to purchase a non Medicare product like Long Term Care insurance.
Clearly Medicare Part B will not cover things that are already covered by Part A and Part D. Like your employers plan or plans that can be obtain on the individual market prior to qualifying for Medicare, Medicare does not cover cosmetic procedures as this would not be classified as medically necessary.
While you might be able to obtain limited coverage through a Medigap plan or Medicare Advantage plan, Original Medicare does not typically cover routine dental, vision, hearing, hearing aids, or routine foot care.
You also have the option to buy a more comprehensive dental and vision plan if you so choose.
What is my Cost Sharing Under Original Medicare Part B?
If you are like most people you not only want to know how much my monthly premium is going to be, but also what what does it cost to use my Medicare insurance. The answer to this question all depends on if you only sign up for Part A & Part B, or if you obtain a Medicare Supplement Plan or leave Original Medicare and sign up for a Medicare Advantage plan.
If you only obtain Original Medicare with no Medigap plan, you will be responsible to pay your Part B monthly premium plus a percentage of the total cost of your Part B services. Typically, these costs are broken down in the following way:
- Part B monthly premium $170.10 for 2022 plan year
- Annual Medicare Part B deductible ($233) for 2022
- 20% co-insurance total cost of your bill, with no limits or cap.
- Any excess charges that a provider or facility may charge beyond what Medicare reimburses (15% max excess charge)
The most significant cost you could face will be the 20% co-insurance and the 15% excess charge. As you get older we face larger medical procedures that come at a very high cost. Research shows that 1 in 3 people age 65 or older will get diagnosed with cancer. Bill related to chemotherapy can add up to some pretty significant amounts.
Thankfully there are alternative solutions that are available to you. These solution solve a real financial problem that was left behind by Original Medicare. There are several Medicare supplemental plan options available that can either completely eliminate all bills or plans that put reasonable caps to your max out of pocket cost.
Another option you might want to consider is a Medicare Advantage plan. These plans can offer benefits that may not be found in a Medicare Supplement plan and should be considered as part of your overall investigation. Each of these plans have an insurance premium that will not break your bank.
I hope you are finding this information very helpful. If you would like to talk with one of our Medicare Insurance Agents, please give us a call and we can help you further (562) 735-3553.
I didn't sign up for Medicare Part B during my
initial enrollment period, when can I sign up?
Medicare beneficiaries who did not sign up for Medicare Part B during their initial enrollment period, or Part A if you are required to buy it, can enroll during a General Enrollment Period. The general enrollment period happens each year from January 1 – March 31.
It is important to know that is you are enrolling into Part B during the general enrollment period, your Medicare Part B coverage will not begin until July 1 of the year you enroll.
If you are enrolled into Part A but not Part B as you are currently covered by a qualified Group Health Insurance plan, you are able to enroll into Part B at anytime.
Once you are dis-enrolled from a group health insurance plan, you qualify for a Special Enrollment Period that occurs for an 8 month period immediately following the last month you had coverage through a group health plan.
You will also need to make sure you sign up for a Part D prescription drug plan once you are no longer covered by an employers plan.