Medicare Part B (Medical Insurance)

By: Meredith Miller
Published: Wednesday, July 25 2018
Last Updated: 4 years ago

Though there are millions of Americans using Medicare for their medical insurance coverage, not all understand the differences within the program. Medicare Part B handles different services than Part A and Part D.

In addition, there are also eligibility and cost differences within the program that set Medicare Part B apart from the other Medicare plans. For instance, the medical services covered by Medicare Part B are vastly different than those covered by Medicare Part A. Here’s a look at what Medicare Part B does for you.

What is Medicare Part B

Medicare Part B deals with medical insurance coverage. Meaning, it helps cover medically necessary supplies and services you need for your treatment or diagnosis of a condition. On top of medically necessary services, Medicare Part B can help you pay for many preventive services in the cases of early detection or prevention.

Many individuals who have Medicare Part A qualify for Medicare Part B as well. However, it is still important to understand whether or not you meet Medicare Part B eligibility requirements beforehand in addition to learning about what is covered, what may be your Medicare Part B premium every month, etc.

What is Covered Under Medicare Part B?

There are a variety of services you can receive help paying for with Medicare Part B coverage. With that said, there are certain conditions that surround the coverage you may or may not receive. For instance, coverage can depend on your personal health condition or the specific setting.

Summary of Medicare Part B Covered Services

Medicare Part B coverage contains a range of supplies, services, and preventive treatments. Here’s what you can expect to get covered for with your Part B plan.

1. Doctor/Hospital/Home Health Care

Those who meet certain Medicare Part B eligibility requirements can receive help paying for a number of services in and out of a hospital. These tend to be outpatient-related. For example, clinical research trials can be covered under Part B, however, there are limitations to it.

Room and board may be covered, but coinsurances and deductibles generally are not covered.

You can also receive coverage some durable medical equipment (DME) that you may need at home for your treatment. This includes wheelchairs, walkers, oxygen equipment, and more.

Additional Medicare Part B coverage for hospital or home health care includes:

  • Ambulatory surgery center fees
  • Emergency room visits
  • Mental health services (outpatient, inpatient, partial hospitalization)
  • Short-term home health services
  • Visiting a doctor for a second opinion

2. Preventive Diagnosis/Treatment

With Medicare Part B coverage, your medical insurance can also cover preventive services in the case of a diagnosis or preventing an illness. Some of what you may see covered include:

  • Physical examinations
  • Lab services (e.g. blood tests, urinalysis)
  • Screenings (e.g. cancer, diabetes, pap tests)

Medicare Part B coverage also involves preventive shots. In many cases, these shots are done on a yearly basis. This includes the flu shot and pneumococcal vaccines.

Beyond the information above, your medical insurance can cover the likes of occupational and physical therapy, prosthetic devices, nurse practitioner services, limited outpatient prescription drugs, and more.

If you want to learn more about what preventive services can be found under your Medicare Part B coverage, you can always read the list or speak with your healthcare provider for more information.

Medicare Part B Eligibility

With an understanding of what Medicare Part B covers, it is best to understand whether or not you even meet Part B eligibility requirements so that you can take advantage of its covered services. In general, this will depend largely on if you are eligible for premium-free Part A coverage or you must pay for your Part A.

Those of you who are eligible for premium-free Part A have already met Medicare Part B eligibility requirements for enrollment.

However, for those that have to pay the Part A premium, there are specific requirements for this Medicare plan that must be met:

  • Be 65-years-old or older
  • Be a U.S. citizen
  • Be a U.S. citizen or alien with lawful permanent residency.

For the last eligibility requirement, if you are a legal alien, then you must reside in the U.S. for at least five continuous years before the month you file for your Medicare.

In addition to that, individuals who are disabled or who are dealing with end-stage renal disease (ESRD) are also eligible for Part B coverage.

Medicare Part B Enrollment

In addition to meeting eligibility requirements, you also should pay close attention to the enrollment process. Part B enrollment can only happen at certain times. Some receive automatic enrollment, while others do not.

For automatic enrollment into this medical insurance, you must already receive Social Security or Railroad Retirement Board (RRB) benefits, and you should receive them for at least four months before being eligible for Medicare.

With automatic enrollment, you are actually given a choice as to whether or not you want to hold onto your Part B coverage or stick with Part A.

If you are not capable of automatic enrollment, then you must enroll during the enrollment period as you would with other health insurance. For those that miss it, you will have to pay a late fee.

Medicare Part B Cost

Once you understand Medicare Part B eligibility, it is time to focus on Medicare Part B cost. This cost can vary patient to patient depending on income. In most cases, costs are standard. However, some of you may qualify for an Income Related Monthly Adjustment Amount (IRMAA).

Nevertheless, it is important to understand the different Medicare Part B cost expenses you'll be dealing with such as your Medicare Part B premium out-of-pocket costs, and more.

Another factor to consider when it comes to the Medicare Part B cost is the late enrollment fee previously mentioned. This can cause your Medicare Part B premium to go up (usually 20% or so), and you must pay this fee for the timeframe that you have this Medicare plan.

Medicare Part B Premiums

What your Medicare Part B premium is and how you pay for it depends on certain circumstances. Typically, you do not have to worry about going in every month to pay for the Medicare Part B premium if you receive benefits from Social Security, RRB, or Office of Personnel Management. In this case, the Medicare Part B cost is automatically deducted from your benefit payment.

In general, for those who do not receive the IRMAA, you will pay the standard Medicare Part B premium for 2018, which is $134. Sometimes, that monthly payment can actually be higher based on your income, or it can be lower if you receive Social Security benefits.

Your Medicare Part B premium can also change depending on how you file your tax return (individual and joint).

Other Medicare Part B Out-of-Pocket Costs

With Medicare Part B coverage, your medical insurance often deals with out-of-pocket costs such as a coinsurance. In this case, this Medicare Part B cost is different than what you pay for your Medicare Part B premium.

Your deductible alone for Medicare Part B is typically $183 per year for 2018. Once this occurs, you will typically pay about 20% for the rest of your Medicare coverage costs. This payment for your medical insurance usually handles outpatient therapy, DME, and the majority of doctor services, including inpatient care.